Folate Supplement Improves Response to Methotrexate in RA

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Folate Supplement Improves Response to Methotrexate in Rheumatoid Arthritis

Ann Rheum Dis 2003;62:423-426.

http://www.medscape.com/viewarticle/455446

NEW YORK (Reuters Health) May 12 - A variety of factors, including folate

supplementation, influence toxicity, efficacy and other aspects of methotrexate

therapy in patients with rheumatoid arthritis, Dutch researchers report

in the May issue of the ls of the Rheumatic Diseases.

Dr. M. Hoekstra of Medisch Spectrum Twente, Enschede, and colleague

note that although methotrexate is an effective disease-modifying drug

in such patients, factors influencing toxicity, efficacy and final dosage

are not well defined.

To explore factors relevant to daily clinical practice, the researchers

studied data from a 48-week clinical trial of methotrexate therapy, starting

at 7.5 mg/week, in rheumatoid arthritis patients. The subjects had been

randomized to receive folate or placebo supplementation.

Analysis showed that folate supplementation was "strongly" related to

a lack of hepatotoxicity. A high body mass index (BMI) was related to its

occurrence. Prior gastrointestinal (GI) events and being younger were associated

with diarrhea.

The main reasons for withdrawal from treatment were hepatotoxicity and

adverse GI events. These were associated with lack of folate supplementation,

BMI, prior GI events and being female.

Treatment efficacy was associated with low disease activity at baseline,

being male, use of non-steroidal anti-inflammatory drugs and lower creatinine

clearance.

Overall, the researchers suggests that in light of these findings, patients

without prior GI events or a high BMI, who have a calculated creatinine

clearance of 50 mL/min or more, "can start with 15 mg/week methotrexate

provided that folates are added to the treatment."