RESEARCH - Reducing toxicity of MTX with folic acid

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Z Rheumatol. 2005 Jun;64(5):353-8.

[Reducing toxicity of methotrexate with folic acid][Article in German]

Harten P.

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.

PMID: 15965822

http://www.ncbi.nlm.nih.gov/pubmed/15965822

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