EFFECT OF FOLIC ACID SUPPLEMENTATION ON THE EFFICACY AND TOLERABILITY OF DIFFERENT FORMS OF METHOTREXATE IN RHEUMATOID ARTHRITIS PATIENTS

Abstract. Objective: to evaluate the effect of folic acid (FA) supplementation on the efficacy and tolerability of tablet and injectable forms of methotrexate (MT) in patients with rheumatoid arthritis (RA).
Materials and methods: the case histories of 170 patients with a reliable diagnosis of RA were retrospectively analyzed. The age of the patients was 53.7±10.9 years.All patients received MT therapy for 6 to 144 months (87.4±6.9) at a dose of 7.5 to 20 mg/week (14±3.8). Patients were divided into two groups: those who received and those who did not receive standard FC supplements at a dose of 5 mg/week. The efficacy and tolerability of different forms of MTs depending on the prescriptions with FC were evaluated. The efficacy of therapy was determined by the dynamics of the DAS28 index. Tolerability was determined by the frequency of adverse events (AEs): stomatitis, cytopenia, dyspepsia, elevated transaminases.
Results: First, a statistically significant predominance of the efficacy of MT without FC supplementation was found: p=0.02 and OR=0.46; 95%CI 0.23 to 0.91, and specifically its injectable form: pБ 0.001, OR=16.3; 95%CI 5.08 to 51.3. Second, synthetic FC may increase the frequency of side effects: p=0.004, OR=2.52; 95%CI 1.35 - 4.95. Administration of the subcutaneous form of MT without FC supplementation was not associated with an increased incidence of adverse reactions compared to the tablet form: p< 0.001, OR=25; 95%CI 7.7 - 80.7 and compared to patients who received MT injections with FC: p=0.002, OR=0.2; 95%CI 0.1 - 0.6. Additional intake of FC does not affect the correction of side effects when using MT injections and in some cases is able to level them when using the tablet form.
Conclusion: The results of the observation suggest that the subcutaneous form of MT has a greater therapeutic effect compared to the tablet form. The maximum therapeutic potential can be achieved with the injectable form of MTs without the addition of FC. The feasibility of routine use of PC in MT therapy with RA is questionable. Synthetic PC can both increase the frequency of adverse events of oral MTs and neutralize them. It is possible that the multidirectional effects are related to folate levels in the body. The development of side effects in some cases is corrected by supplementation with synthetic FA.

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