Patient perspectives on simultaneous methotrexate-folic acid intake to improve adherence in rheumatoid arthritis: a cross-sectional survey.

Abstract

Objective: To assess real-world adherence to folic acid (FA) supplementation with methotrexate (MTX) and patient perceptions of a simplified, same-day dosing strategy in RA.

Methods: We conducted a cross-sectional online survey co-designed with patient representatives and distributed by the French patient association AFPric. RA patients treated with MTX were eligible. The questionnaire captured MTX and FA regimens, omissions, adverse events and attitudes toward same-day MTX and FA administration. Analyses were descriptive with prespecified subgroup comparisons.

Results: Among 967 respondents (86.8% women; mean age 62.4 years), 86.7% reported once-weekly FA supplementation. Overall, 25.5% reported at least occasional FA omission, with omissions more frequent among long-term MTX users. Nausea after MTX was reported by 46.6% of respondents and by 52.6% of those reporting FA omissions. A same-day MTX and FA regimen was perceived as simpler by 30.5% and 41.5% believed it could reduce FA omission. Overall, 64.8% indicated that they would be willing to participate in a randomised controlled trial evaluating simultaneous administration.

Conclusion: One in four people with RA treated with MTX reported FA omissions. Many respondents believed that a same-day regimen could reduce FA omissions, and interest in participating in a clinical trial was high. These findings support the feasibility of prospectively evaluating whether same-day MTX and FA administration may improve adherence and tolerability in selected patients, particularly those receiving once-weekly FA supplementation, without compromising MTX effectiveness.