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Concomitant use of folic or folinic acid was first suggested to prevent gastrointestinal toxicity in patients who take methotrexate for rheumatoid arthritis. Since then, others have suggested that folate agents might also lessen risks for hematologic and hepatic toxicity. Studies on the effects of these agents on methotrexate efficacy have produced conflicting results.
These authors performed a systematic review to evaluate whether concomitant folic acid or folinic acid therapy lessened methotrexate-linked toxicity or decreased its efficacy. They included six randomized trials involving 648 methotrexate recipients, of whom 257 received placebo, 198 received folic acid, and 193 received folinic acid.
They found that concomitant folic acid or f…