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[Reducing toxicity of methotrexate with folic acid].

Abstract

BACKGROUND

Methotrexate is considered to have the best ratio of efficacy to toxicity of the disease modifying antirheumatic drugs. Recently it has been shown to enhance the life expectancy of patients with rheumatoid arthritis. Some 30-60% of RA patients discontinue MTX treatment within 1 year because of side-effects. In this review, the current data about supplementation with folate or folinic acid and their effect on the toxicity and efficacy of low-dose methotrexate therapy are analysed.

METHODS

A Medline search was performed using "folate", "folic acid", "folinic acid", "homocysteine", "methotrexate", "cardiovascular", "heart infarction" and "rheumatoid arthritis" as search terms. The relevant literature was reviewed and other papers referred to as references were explored.

CONCLUSION

Both folate and folinic acid reduce methotrexate toxicity and the discontinuation rate, and decrease methotrexate-induced hyperhomocysteinemia. Folate is less expensive, more secure and easier to handle than folinic acid. The efficacy of methotrexate probably decreases slightly, but the benefit outweighs the risk. Folate supplementation should, therefore, be routinely prescribed to every patient taking low-dose methotrexate.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    pharten11@hotmail.com

    Source

    Zeitschrift fur Rheumatologie 64:5 2005 Jun pg 353-8

    MeSH

    Antirheumatic Agents
    Clinical Trials as Topic
    Drug Combinations
    Folic Acid
    Folic Acid Antagonists
    Hematologic Diseases
    Humans
    Methotrexate
    Rheumatic Diseases
    Treatment Outcome

    Pub Type(s)

    English Abstract
    Journal Article

    Language

    ger

    PubMed ID

    15965822

    Citation

    Harten, P. "[Reducing Toxicity of Methotrexate With Folic Acid]." Zeitschrift Fur Rheumatologie, vol. 64, no. 5, 2005, pp. 353-8.
    Harten P. [Reducing toxicity of methotrexate with folic acid]. Z Rheumatol. 2005;64(5):353-8.
    Harten, P. (2005). [Reducing toxicity of methotrexate with folic acid]. Zeitschrift Fur Rheumatologie, 64(5), pp. 353-8.
    Harten P. [Reducing Toxicity of Methotrexate With Folic Acid]. Z Rheumatol. 2005;64(5):353-8. PubMed PMID: 15965822.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [Reducing toxicity of methotrexate with folic acid]. A1 - Harten,P, PY - 2004/02/15/received PY - 2004/06/16/accepted PY - 2005/6/21/pubmed PY - 2005/9/24/medline PY - 2005/6/21/entrez SP - 353 EP - 8 JF - Zeitschrift fur Rheumatologie JO - Z Rheumatol VL - 64 IS - 5 N2 - BACKGROUND: Methotrexate is considered to have the best ratio of efficacy to toxicity of the disease modifying antirheumatic drugs. Recently it has been shown to enhance the life expectancy of patients with rheumatoid arthritis. Some 30-60% of RA patients discontinue MTX treatment within 1 year because of side-effects. In this review, the current data about supplementation with folate or folinic acid and their effect on the toxicity and efficacy of low-dose methotrexate therapy are analysed. METHODS: A Medline search was performed using "folate", "folic acid", "folinic acid", "homocysteine", "methotrexate", "cardiovascular", "heart infarction" and "rheumatoid arthritis" as search terms. The relevant literature was reviewed and other papers referred to as references were explored. CONCLUSION: Both folate and folinic acid reduce methotrexate toxicity and the discontinuation rate, and decrease methotrexate-induced hyperhomocysteinemia. Folate is less expensive, more secure and easier to handle than folinic acid. The efficacy of methotrexate probably decreases slightly, but the benefit outweighs the risk. Folate supplementation should, therefore, be routinely prescribed to every patient taking low-dose methotrexate. SN - 0340-1855 UR - https://www.unboundmedicine.com/medline/citation/15965822/[Reducing_toxicity_of_methotrexate_with_folic_acid]_ L2 - https://dx.doi.org/10.1007/s00393-005-0638-3 DB - PRIME DP - Unbound Medicine ER -