A Pilot Randomized Controlled Double-Blind Trial of High- Versus Low-Dose Weekly Folic Acid in People With Rheumatoid Arthritis Receiving Methotrexate

• Published in: Journal of clinical rheumatology Vol. 25; no. 7; p. 284
• Main Authors: Stamp, Lisa K, OʼDonnell, John L, Frampton, Christopher, Drake, Jill, Zhang, Mei, Barclay, Murray, Chapman, Peter T
• Format: Journal Article
• Language: English
• Published: United States 01.10.2019
• Subjects: Adult; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - adverse effects; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Dose-Response Relationship, Drug; Double-Blind Method; Drug Monitoring - methods; Drug-Related Side Effects and Adverse Reactions - etiology; Drug-Related Side Effects and Adverse Reactions - prevention & control; Female; Folic Acid - administration & dosage; Humans; Male; Methotrexate - administration & dosage; Methotrexate - adverse effects; Middle Aged; Patient Acuity; Pilot Projects; Treatment Outcome; Vitamin B Complex - administration & dosage
• ISSN: 1536-7355
• DOI: 10.1097/RHU.0000000000000848

The aim of this study was to determine whether reducing the dose of supplemental folic acid used in conjunction with methotrexate (MTX) therapy in people with active rheumatoid arthritis (RA) improved disease control and/or increased MTX-related adverse effects. A randomized double-blind randomized controlled trial comparing 5 mg/wk and 0.8 mg/wk folic acid was undertaken. Rheumatoid arthritis patients on MTX for 3 months or more at a stable dose for 1 month or more were recruited. All participants had DAS28 of 3.2 or greater or required a change in therapy determined by the treating clinician. Disease activity, full blood count, liver function tests, red blood cell (RBC) folate, and RBC MTX polyglutamates were assessed at weeks 0, 4, 8, 16, and 24 along with reports of adverse events. Forty participants were recruited. The mean (SD) change in RBC folate between week 0 and 24 was +87.9 (57.4) nmol/L in the high-dose group and -113.3 (65.7) nmol/L in the low-dose group (p < 0.05). There was no significant difference in the change in DAS28 between the high- and low-dose groups at 24 weeks (-0.13 [95% confidence interval, -0.69 to 0.43] vs -0.25 [-0.87 to 0.37], respectively [p = 0.78]). There was no significant difference in MTX-related adverse effects between the 2 groups. A reduction in RBC folate secondary to reduction in folic acid dose was not associated with a change in RA disease activity or MTX-related adverse effects. The prevention of MTX-related adverse effects remains the primary reason for coprescribing folic acid with MTX. Australian New Zealand Clinical Trials Registry (ANZCTR12610000739011).