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4CPS-088 Folic acid, folinic acid and hematotoxic treatments: a review at a university hospital centre
  1. AM Hami,
  2. M Hocine,
  3. F Petan-Ranguin,
  4. D Auvray,
  5. G Maquin,
  6. G Baroux
  1. University Hospital Centre Of Montpellier, Internal Use Pharmacy Of Saint-Eloi, Montpellier, France


Background and Importance Studies have shown that folic acid (FA) and folinic acid (FAi) are equally effective in preventing methotrexate-related haematotoxicity. According to its marketing autorisation (MA), FA is indicated for the treatment of folate deficiency, chronic intestinal absorption disorders and supplementation during pregnancy and FAi for the prevention and correction of haematotoxicity caused by co-trimoxazole (CMX), pyrimethamine (PYM) and methotrexate (MTX).

Aim and Objectives Assessment of the compliance of prescriptions with the indications for FA and FAi at our university hospital centre (UHC).

Material and Methods A retrospective study was carried out on nominative deliveries in 2022 on 2 UHC establishments. The indication (prevention or supplementation), whether it was combined with haematotoxic treatment, and the search for vitamin B9 (VB9) deficiency prior to initiating treatment were sought using the prescription assistance software.

Results 266 patients were included in our study: 56% (n=150) received FA and 44% FAi (n=116). 84% of prescriptions complied with MA indications.

Regarding FA, a VB9 dosage was performed in 42% (n=63) of patients and a deficiency was observed in 57% (n=36) of cases. 90% (n=135) of patients received it for a supplementation and 10% (n=15) to prevent haematotoxicity due to treatment (n=11 on CMX, n=4 on MTX) and are therefore off-label.

Regarding AFi, a VB9 dosage was performed in 20% (n=23) of patients and a deficiency was identified in 22% (n=5). In 77% (n=89) of cases, FAi was used to prevent haematotoxicity during treatment (n=85 on CMX, n=3 on PYM, n=1 on MTX) and 23% (n=27) received it as a supplement and are therefore off-label.

Conclusion and Relevance Some prescriptions don’t correspond to the MA indications, and the efficacy of FA has not been demonstrated in the prevention of CMX haematotoxicity. Moreover, the unit cost of FAi is higher: failure to comply with the indications may result in higher treatment costs.

Disagreement between prescribers is observed through the heterogeneity of prescriptions. To reduce the rate of non-compliant prescriptions, consultation between doctors and pharmacists needs to be developed to reach a consensus.

References and/or Acknowledgements 1. Shea B, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD000951.pub2.

Conflict of Interest No conflict of interest.

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