Cochrane · systematic review · CD000951
Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis
Shea, B, Swinden, MV, Tanjong Ghogomu, E, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
MusculoskeletalAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
21
current version
GRADE rated
21
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 3 · 14.3%Moderate 18 · 85.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Folic or folinic acid (any) compared to placebo for reducing side effects in patients receiving methotrexate for rheumatoid arthritis
Population: Patients receiving methotrexate for rheumatoid arthritis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
GI side effects (nausea, vomiting, abdominal pain) Folic or folinic acid (any) vs placebo | RR 0.74 [0.59, 0.92] | 6 studies · 644 participants | Moderate |
Stomatitis / mouth sores (incidence) Folic or folinic acid (any) vs placebo | RR 0.72 [0.49, 1.06] | 4 studies · 575 participants | Moderate |
Liver toxicity (incidence of transaminase elevation) Folic or folinic acid (any) vs placebo | RR 0.23 [0.15, 0.34] | 4 studies · 551 participants | Moderate |
Haematological disorders (neutropenia, etc) Folic or folinic acid (any) vs placebo | RR 1.55 [0.4, 5.91] | 2 studies · 443 participants | Low |
Total withdrawals Folic or folinic acid (any) vs placebo | RR 0.39 [0.28, 0.53] | 6 studies · 640 participants | Moderate |
Number of swollen joints Change in number of swollen joints Folic or folinic acid (any) vs placebo | no estimate extracted | 4 studies · 142 participants | Moderate |
Number of tender joints Change in number of tender joints Folic or folinic acid (any) vs placebo | no estimate extracted | 3 studies · 122 participants | Moderate |
Folic acid compared to placebo for reducing side effects in patients receiving methotrexate for rheumatoid arthritis
Population: Patients receiving methotrexate for rheumatoid arthritis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
GI side effects (ie, incidence of nausea, vomiting, abdominal pain) Folic acid vs placebo | RR 0.76 [0.57, 1.01] | 3 studies · 355 participants | Moderate |
Stomatitis / mouth sores (incidence) Folic acid vs placebo | RR 0.9 [0.53, 1.54] | 2 studies · 302 participants | Moderate |
Liver toxicity (ie, incidence of transaminase elevation) Folic acid vs placebo | RR 0.19 [0.1, 0.36] | 2 studies · 302 participants | Moderate |
Haematological disorders (incidence of neutropenia, etc) Folic acid vs placebo | RR 1.7 [0.42, 6.96] | 2 studies · 443 participants | Low |
Total withdrawals Folic acid vs placebo | RR 0.43 [0.29, 0.64] | 3 studies · 343 participants | Moderate |
Number of swollen joints with folic acid (≤7 mg/wk) Change in number of swollen joints Folic acid vs placebo | no estimate extracted | 1 study · 42 participants | Moderate |
Number of tender joints with folic acid (≤7 mg/wk) Change in number of tender joints Folic acid vs placebo | no estimate extracted | 1 study · 42 participants | Moderate |
Folinic acid compared to placebo for reducing side effects in patients receiving methotrexate for rheumatoid arthritis
Population: Patients receiving methotrexate for rheumatoid arthritis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
GI side effects (nausea, vomiting, abdominal pain) Folinic acid vs placebo | RR 0.78 [0.59, 1.02] | 4 studies · 426 participants | Moderate |
Stomatitis / mouth sores (incidence) Folinic acid vs placebo | RR 0.7 [0.46, 1.07] | 3 studies · 410 participants | Moderate |
Liver toxicity (incidence of transaminase elevation) Folinic acid vs placebo | RR 0.27 [0.16, 0.44] | 3 studies · 358 participants | Moderate |
Haematological disorders (neutropenia, etc) Folinic acid vs placebo | RR 1.46 [0.25, 8.59] | 1 study · 278 participants | Low |
Total withdrawals Folinic acid vs placebo | RR 0.35 [0.23, 0.53] | 3 studies · 386 participants | Moderate |
Number of swollen joints with folinic acid (≤7 mg/wk) Change in number of swollen joints Folinic acid vs placebo | no estimate extracted | 3 studies · 100 participants | Moderate |
Number of tender joints with folinic acid (≤7 mg/wk) Change in number of tender joints Folinic acid vs placebo | no estimate extracted | 2 studies · 80 participants | Moderate |