POS1510-HPR TAKING FOLIC ACID AT THE SAME TIME AS METHOTREXATE COULD REDUCE FOLIC ACID NON-COMPLIANCE AND SIMPLIFY TREATMENT ADMINISTRATION IN RHEUMATOID ARTHRITIS
Authors: E. Dalix, N. Hamamouche, I. Pico Philippe, S. Rollot, H. Marotte
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> All guidelines recommend the use of methotrexate (MTX) as a first-line treatment for rheumatoid arthritis (RA). To improve tolerability, the use of folic acid (FA) is recommended, but there is no precise schedule for its use, with FA taken separately from MTX in current practice. However, no clinical study has confirmed this. In rodents, simultaneous administration of MTX and FA does not affect MTX efficacy on arthritis [1]. <h3>Objectives:</h3> Before proposing a clinical study testing the simultaneous administration of MTX and FA, we conducted a cross-sectional online survey to test the usefulness of this study from the patient's point of view. <h3>Methods:</h3> The online survey was carried out via the SANOÏA platform among French RA patients of the AFP<sup>ric</sup> association. The questionnaire was drawn up in association with scientists, rheumatologists, and representatives of the AFP<sup>ric</sup> association. On October 25, 2023, the survey was sent out to AFP<sup>ric</sup> members, and 1,238 answers were received within 12 days. Only 967 answers (78%) were included in the analysis. Reasons for exclusion from the analysis were minority status, no consent to data use, no diagnosis of RA, no MTX and/or no FA treatment. Analysis of data was realized by Fisher's or Pearson's Chi-squared tests, using R software. <h3>Results:</h3> The respondent population had the main characteristics of a RA population, with a majority of women (86.8%), a mean age of 62.4±11.3 years (range: 21-88 years). Almost half (49.4%) of patients were treated with MTX for more than 10 years (Table 1). FA was used as a single weekly dose in 86.7% of patients. A quarter of patients (25.5%) declared to forget FA treatment, especially in those treated with MTX for at least 10 years. In patients who reported forgetting FA treatment, 10.8% declared forgetting FA with a high frequency (from all the time to often), 16.2% with a moderate frequency, 35.2% with a slight frequency, and 38.5% with a rare frequency. Patients taking MTX less than 10 years trended to forget FA more often (moderate: 20.4%; slight: 29.6%) than patients taking MTX for at least 10 years (moderate: 12.9%; slight: 39.6%). Regarding MTX tolerance, 46.6% of patients reported nausea within 48 hours after taking MTX. 52.6% of patients forgetting FA reported nausea after MTX intake. Nausea were increased in 16.2% of patients forgetting FA, especially in patients starting MTX (from 0 to 2 years; Table 2). Among patients taking FA more than once a week, over a third (36.8%) considered that it would be simpler or significantly simpler to take it once a week. Among the total population, almost a third (30.5%) considered that taking FA concomitantly with MTX would be simpler. On the other hand, 41.4% felt that taking FA and MTX on the same day would make it easier not to forget the FA. Finally, 64.8% of patients would be willing to take part in a clinical trial to evaluate the effects of taking MTX and FA together. <h3>Conclusion:</h3> This survey confirms the difficulty of taking FA at a distance from MTX in around a third of patients, and the willingness of patients (2/3 of them) to participate in a clinical study testing simultaneous use of MTX and FA. <h3>REFERENCES:</h3> [1] Dalix E et al. Similar effect of co-administration of methotrexate and folic acid for the treatment of arthritis compared to separate administration. Rheumatology (Oxford). 2023 Apr 3;62(4):1706–10. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Elisa Dalix: None declared, Naima Hamamouche: None declared, Irène Pico Philippe: None declared, Sandrine Rollot: None declared, Hubert Marotte Nordic Pharma, Nordic Pharma, Medac, Accord.