Introduction: Methotrexate (MTX) is an effective treatment option for patients with moderate-to-severe psoriasis. As psoriasis is an incurable disease, the goal of the MTX treatment is to suppress psoriasis, achieving long-term remissions with minimal treatment-related adverse events (AEs).
Areas covered: Supplementation with folate - either folic acid (FA) or folinic acid - may reduce the side effects of MTX therapy. There are no consistent, evidence-based guidelines for folate supplementation in this clinical setting. We present data concerning the impact of folic supplementation on the safety and efficacy of MTX therapy for psoriasis. An extensive search (1960 - March 2014) identified few studies addressing with just one randomized controlled trial (RCT) and some case series. This meager yield underlines the need for further studies, especially RCTs, in this group of patients.
Expert opinion: FA may be effective in diminishing the severity of AEs in patients with psoriasis treated with MTX and should be recommended. Supplementation with too high doses of FA may influence the efficacy of treatment.
Keywords: folic acid supplementation; methotrexate; psoriasis.