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Comparison of two different folic acid doses with methotrexate – a randomized controlled trial (FOLVARI Study)

Overview of attention for article published in Arthritis Research & Therapy, June 2015
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (78th percentile)

Mentioned by

1 news outlet
1 Facebook page


23 Dimensions

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84 Mendeley
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Comparison of two different folic acid doses with methotrexate – a randomized controlled trial (FOLVARI Study)
Published in
Arthritis Research & Therapy, June 2015
DOI 10.1186/s13075-015-0668-4
Pubmed ID

Varun Dhir, Amit Sandhu, Jasbinder Kaur, Benzeeta Pinto, Phani Kumar, Prabhdeep Kaur, Nidhi Gupta, Ankita Sood, Aman Sharma, Shefali Sharma


There is reasonable evidence that folic acid 5-10 mg per week leads to reduction in methotrexate (MTX) toxicity in rheumatoid arthritis (RA). However, this is based on studies conducted with lower MTX dosage than used currently. It is unclear whether higher doses of folic acid may be better in reducing toxicity. This was a double-blind randomized controlled trial of 24 weeks duration. To be eligible, patients should have rheumatoid arthritis (1987 American College of Rheumatology criteria), be 18-75 years of age, not be on MTX and have active disease as defined by 'Modified Disease Activity Score using three variables' [DAS28(3)] > 3.2. MTX was started at 10 mg/week and escalated to 25 mg/week by 12 weeks. Folic acid was given at a dose of 10 mg (FA-10) or 30 mg per week (FA-30). Co-primary endpoints were incidence of toxicity (undesirable symptoms and laboratory abnormalities) and change in disease activity by 24 weeks. Intention-to-treat and per-protocol analyses were performed. Among 100 patients enrolled, 51 and 49 were randomized to FA10 and FA30 respectively. By 24 weeks, there were 6 patient withdrawals in either group and mean(±SD) dose of MTX was 22.8 ± 4.4 and 21.4 ± 4.6 mg per week (p = 0.1). Frequency of patients with undesirable symptoms was non-significantly lower by 7.4 % (95 % confidence interval -27.4 to 12.7 %) in FA10 compared to FA30. There was also no difference in frequency of transaminitis [>Upper limit of normal (ULN)] (42.6, 45.7 %, p = 0.7) or transminitis as per primary outcome (>2xULN) (10.6, 8.7 %, p = 1.0) or cytopenias (4.3, 4.3 %, p = 0.9). There was no difference in the primary end-point of occurrence of any adverse effect (symptom or laboratory) in FA10 and FA30 (46.8, 54.3 %, p = 0.5). At 24 weeks, DAS28(3) declined in both groups by a similar extent (-1.1 ± 1.0, -1.3 ± 1.0, p = 0.2) and 'European League Against Rheumatism' good or moderate response occurred in 56.9 and 67.4 % (p = 0.3). Even with the high doses of MTX used in current practice, there was no additional benefit (or harm) of a higher dose of folic acid (30 mg/week) over a usual dose (10 mg/week). Clinicaltrials.gov NCT01583959 Registered 15 March 2012.

Mendeley readers

The data shown below were compiled from readership statistics for 84 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 1%
Unknown 83 99%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 14 17%
Researcher 11 13%
Student > Master 11 13%
Other 10 12%
Student > Ph. D. Student 9 11%
Other 16 19%
Unknown 13 15%
Readers by discipline Count As %
Medicine and Dentistry 37 44%
Pharmacology, Toxicology and Pharmaceutical Science 10 12%
Nursing and Health Professions 7 8%
Biochemistry, Genetics and Molecular Biology 6 7%
Agricultural and Biological Sciences 2 2%
Other 5 6%
Unknown 17 20%

Attention Score in Context

This research output has an Altmetric Attention Score of 8. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 22 September 2021.
All research outputs
of 20,543,859 outputs
Outputs from Arthritis Research & Therapy
of 2,799 outputs
Outputs of similar age
of 279,472 outputs
Outputs of similar age from Arthritis Research & Therapy
of 1 outputs
Altmetric has tracked 20,543,859 research outputs across all sources so far. Compared to these this one has done well and is in the 82nd percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 2,799 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.3. This one has gotten more attention than average, scoring higher than 71% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 279,472 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 78% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them