Folic Acid in Pediatric Inflammatory Bowel Disease
Status:
Unknown status
Trial end date:
2020-05-01
Target enrollment:
Participant gender:
Summary
Inflammatory bowel disease often requires immunomodulators, such as methotrexate, to maintain
disease remission. This medication is administered as one dose weekly. Methotrexate can cause
folic acid deficiency, so the current recommendation is to give daily folic acid
supplementation while on methotrexate. Standard of care is to administer folic acid
supplements daily. Patient compliance with daily folic acid is often suboptimal. The
rationale is that weekly folic acid supplementation is as efficacious as daily dosing, and
less frequent dosing likely will help improve patient compliance. The optimal dosing schedule
of folate supplementation in relation to methotrexate is not known and there are not many
research studies that have studied changing dosing of folate supplementation. One particular
research study examined the effect of different dosing of folic acid supplements in patients
with rheumatoid arthritis taking methotrexate. The study showed that folic acid at two
different doses per week (5 mg low dose vs 27.5 mg high dose) did not effect the efficacy of
methotrexate therapy, and patients who were on either folic acid supplementation had lower
toxicity scores compared to patients not on folic acid supplementation. This study shows that
folic acid dosed once per week can be useful in preventing methotrexate toxicity for
rheumatoid arthritis patients. There were no studies that could be found that have studied
this correlation for pediatric inflammatory bowel disease. Based on this current study, once
weekly dosing of folic acid in IBD patients on methotrexate has the potential to be as
efficacious as daily dosing.