Major Research Findings

This research investigated the benefits and harms of folic acid and folinic acid supplementation in reducing the side effects of methotrexate (MTX) in patients with rheumatoid arthritis (RA). 1 The research showed that folic acid and folinic acid supplementation can reduce the risk of gastrointestinal side effects, such as nausea, vomiting, and abdominal pain. 1 Additionally, it was found that these supplements can help prevent abnormal serum transaminase elevation and reduce the risk of patients discontinuing MTX treatment for any reason. 1

Reasons for Side Effects

Methotrexate (MTX) works by inhibiting cell division, which helps to manage symptoms of rheumatoid arthritis. However, this process can also affect the division of cells in the gastrointestinal tract and blood cells, leading to side effects. 1 Folic acid and folinic acid are essential vitamins for cell division, and supplementing them can mitigate the side effects of MTX by supporting proper cellular function. 1

Common Side Effects

Gastrointestinal Side Effects

Common side effects of MTX include gastrointestinal symptoms such as nausea, vomiting, and abdominal pain. 1 This study showed that folic acid and folinic acid supplementation significantly reduced the incidence of these side effects by 26%. 1

Hepatic Dysfunction

MTX can also affect the liver, leading to hepatic dysfunction. 1 The study demonstrated that folic acid and folinic acid supplementation effectively reduced the risk of hepatic dysfunction, as measured by elevated serum transaminase levels, by 77%. 1

Hematologic Side Effects

MTX can impact the production of blood cells. 1 However, this study did not provide conclusive evidence regarding the effects of folic acid and folinic acid on hematologic side effects. 1

Side Effects Management

Gastrointestinal Side Effects

Folic acid and folinic acid supplementation is effective in reducing gastrointestinal side effects. 1 The study showed a 26% reduction in the incidence of these side effects with supplementation. 1

Hepatic Dysfunction

Folic acid and folinic acid supplementation is beneficial in mitigating hepatic dysfunction. 1 The research demonstrated a 77% decrease in the risk of hepatic dysfunction with supplementation. 1

Hematologic Side Effects

Regular blood tests are crucial for monitoring the effects of MTX on blood cell production, and appropriate treatment should be administered if needed. 1 Further research is required to determine the effectiveness of folic acid and folinic acid supplementation in reducing hematologic side effects. 1

Comparison Across Studies

Similarities

The analysis included six studies, all demonstrating that folic acid or folinic acid supplementation reduces MTX side effects. 1

Differences

The studies varied in their designs, participants, and dosages of folic acid or folinic acid. 1

Real-World Application Considerations

Patients undergoing MTX treatment for rheumatoid arthritis should consult with their doctor about folic acid or folinic acid supplementation to minimize side effects. 1 The dosage will be determined individually by the doctor based on the patient's needs. 1

Limitations of Current Research

The research was limited by the small number of studies analyzed, indicating a need for further investigation. 1

Future Research Directions

Future research should involve larger and longer-term studies to further investigate the efficacy of folic acid and folinic acid supplementation. 1

Conclusion

Folic acid and folinic acid supplementation can help reduce side effects in patients undergoing MTX treatment for rheumatoid arthritis. 1 Consult your doctor to determine if supplementation is right for you. 1