Department of Pharmacy, Kyushu University Beppu Hospital, Oita, Japan.
Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan.
Mod Rheumatol. 2021 Jan;31(1):108-113. doi: 10.1080/14397595.2020.1743493. Epub 2020 Mar 30.
We investigated the effect of daily folic acid supplementation on methotrexate (MTX) toxicity and efficacy in Japanese patients with rheumatoid arthritis (RA).
We followed 19 patients treated with MTX who switched from taking weekly 5 mg folic acid supplementation (weekly regimen) to 1.25 mg daily (daily regimen). White blood cell (WBC) and platelet (PLT) counts, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were collected for 24 weeks following the change.
We observed no significant changes in WBC or PLT counts. AST and ALT levels, which had exceeded the upper limits of their normal ranges at the beginning of the study, were improved significantly at weeks 4 and 8, no subsequent deterioration in liver function was found. Further, no significant changes in ESR and CRP levels were observed.
Our data indicate that supplementing 1.25 mg of folic acid daily rather than 5 mg weekly reduces toxicity caused by MTX without affecting its efficacy.
我们旨在研究日本类风湿关节炎（RA）患者接受甲氨蝶呤（MTX）治疗时，每日补充叶酸对 MTX 毒性和疗效的影响。
我们随访了 19 例接受 MTX 治疗的患者，他们将每周 5mg 叶酸补充（每周方案）改为每日 1.25mg（每日方案）。在改变方案后的 24 周内，我们收集了白细胞（WBC）和血小板（PLT）计数、天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平、红细胞沉降率（ESR）和 C 反应蛋白（CRP）水平。
我们观察到 WBC 或 PLT 计数无明显变化。AST 和 ALT 水平在研究开始时已经超过正常范围上限，在第 4 周和第 8 周时显著改善，此后未发现肝功能恶化。此外，ESR 和 CRP 水平无明显变化。
我们的数据表明，每日补充 1.25mg 叶酸而非每周 5mg 叶酸可降低 MTX 引起的毒性，而不影响其疗效。
