Harten P
Z Rheumatol. 2005 Jun;64(5):353-8. doi: 10.1007/s00393-005-0638-3.
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.
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.
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.
甲氨蝶呤被认为是改善病情抗风湿药物中疗效与毒性比例最佳的药物。最近有研究表明，它能提高类风湿关节炎患者的预期寿命。约30% - 60%的类风湿关节炎患者因副作用在1年内停止甲氨蝶呤治疗。在本综述中，分析了目前关于补充叶酸或亚叶酸及其对低剂量甲氨蝶呤治疗毒性和疗效影响的数据。
使用“叶酸”“叶酸酸”“亚叶酸”“同型半胱氨酸”“甲氨蝶呤”“心血管”“心肌梗死”和“类风湿关节炎”作为检索词在Medline数据库进行检索。对相关文献进行综述，并查阅其他作为参考文献引用的论文。
叶酸和亚叶酸均可降低甲氨蝶呤的毒性和停药率，并降低甲氨蝶呤诱导的高同型半胱氨酸血症。叶酸比亚叶酸更便宜、更安全且更易于使用。甲氨蝶呤的疗效可能会略有下降，但益处大于风险。因此，对于每一位服用低剂量甲氨蝶呤的患者，都应常规开具叶酸补充剂。
