Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis.

Study answer

What this study found

Folic acid or folinic acid supplementation was overall protective and did not reduce methotrexate’s anti-rheumatic efficacy. The review found fewer gastrointestinal side effects, less hepatic dysfunction measured by liver enzyme elevations, and fewer methotrexate discontinuations, with a trend toward fewer mouth ulcers. Individual trials showed lower gastrointestinal events in several studies, including 4/44 versus 14/48 in one folinic acid trial and 16/141 versus 55/137 in the largest folic acid trial, while liver toxicity was also reduced, such as 1/44 versus 11/48 and 16/141 versus…

Study & population

Systematic review and meta-analysis of six randomized trials in adults with rheumatoid arthritis receiving low-dose methotrexate in international hospital and clinic settings.

Intervention

Low-dose folic acid or folinic acid was given during methotrexate therapy for rheumatoid arthritis and compared with placebo.

Key limitation

Haematologic side effects could not be clearly assessed because data were limited.

View full study detailsView sourceOpen PDF

Original abstract