L-Methylfolate Calcium Supplementation in Adolescents and Children: A Retrospective Analysis (4226)

Objective: This study aims to determine the efficacy of l-methylfolate for treatment of depressive symptoms and the roles of methylenetetrahydrofolate reductase (MTHFR) mutations in adolescents.

Background: Folate (vitamin B9) is an essential nutrient required for normal functioning of various biochemical pathways, including neurotransmitter synthesis. Folate deficiency has been linked to neuropsychiatric disorders in adolescents and adults. The 677T and A1298C polymorphisms in this gene lead to a reduced ability to convert dietary folate and folic acid from nutritional supplements into l-methylfolate. In patients with MTHFR polymorphisms, l-methylfolate calcium may provide more benefit than folic acid supplementation

Design/Methods: This retrospective chart review analyzed 146 juvenile patients (ages 7–20) prescribed l-methylfolate calcium at a psychiatry clinic in Amherst, NY, between January 1, 2010 and November 10, 2015. Patients treated with l-methylfolate calcium (Deplin®, USA) 15mg (N=139) or 7.5 mg (N=7) daily were identified, and 44 patients prescribed but not administered l-methylfolate calcium were included as a comparator population.

Results: L-methylfolate calcium was well-tolerated within this pediatric and adolescent population (mean ages =16, 17 for treatment and comparator groups, respectively). With the exception of 5 patients for whom genetic testing results could not be retrieved, all participants had at least one copy of either the A1298C or 677T polymorphisms. The proportion of patients experiencing AEs was significantly higher in the comparator population than the treated population (25.0% vs. 10.3% respectively, p=0.020) as was the overall frequency of AEs (.32 vs. .15 per patient respectively, p=0.015). The most common AEs seen in the treated population were impaired sleep (N=5) and increased anxiety (N=3). There was not a statistically significant difference between patients with 677T and other polymorphisms in terms of adverse event frequency (p>1.00 for treatment group, p=0.30 for control group).

Conclusions: This study reflects a potential place in therapy for l-methylfolate calcium in juvenile patients with MTHFR polymorphisms.

Disclosure: Dr. Rainka has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Postgraduate Healthcare Education, LLC, and Biogen. Dr. Rainka has received research support from Alexa, Acadia, ASHP, Dent Family Foundation. Dr. Aladeen has received research support from Alexa, Acadia, ASHP, and Dent Family Foundation. Dr. Westphal has received research support from ASHP%252C%2520Acadia%252C%2520Dent%2520Family%2520Foundation. Dr. Greger has received research support from ASHP, Acadia, Dent Family Foundation.Dr. Meaney has nothing to disclose. Dr. Wojcik has received research support from Dent Family Foundation. Dr. Gengo has received research support from Dent Family Foundation. Dr. Capote has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Nestle Health Science, Pamlab, Inc., Eli Lilly, Merck, Jazz, Pfizer, Novartis, Glaxo Smith Kline, Alekemes, Wyeth, Cephalon, AstraZeneca, Forest, Abbott, Otsuka, Lundbeck, Sunovian. Dr. Capote has received research support from Glaxo Smith Kline and Alexza Pharmaceuticals..