Bernard A. Cooper, MD
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Cooper B.; Folic Acid and Methotrexate in Rheumatoid Arthritis. Ann Intern Med. 1996;124:73. doi: 10.7326/0003-4819-124-1_Part_1-199601010-00018
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Published: Ann Intern Med. 1996;124(1_Part_1):73.
TO THE EDITOR:
Morgan and colleagues  clearly showed that supplementation with folic acid improved methotrexate tolerance in patients with rheumatoid arthritis. However, I find the conclusion that the folate supplement did not alter the efficacy of methotrexate somewhat difficult to accept on the basis of the data presented.
The data summarized in Table 2 of their report show that after 6 months of treatment, joint swelling and tenderness was either unchanged or worse in 39 and 35 patients, respectively, in the placebo group; 33 and 63 patients, respectively, in the low-dose folic acid group; and 13 and 43 patients, respectively, in the high-dose folic acid group. After 12 months of treatment, swelling or tenderness was unchanged or worse in 16 and 31 patients, respectively, in the placebo group; 9 and 43 patients, respectively, in the low-dose folic acid group; and 17 and 23 patients, respectively, in the high-dose folic acid group. I fail to see how one can evaluate efficacy from such data, given the large type II error entailed by the statistical analysis.
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