Benefits of low weekly doses of methotrexate in steroid-dependent asthmatic patients. A double-blind, randomized, placebo-controlled study

Comet, R; Domingo, Christian; Larrosa, M.; Morón, Alexis; Rué, Montserrat; Amengual, M. J.; Marín, A.

doi:10.1016/j.rmed.2005.07.003

Cited by 35 publications

(40 citation statements)

References 28 publications

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“…There are no clear parameters to guide this decision. Our previous experience with methotrexate 9 showed that some patients may tolerate a period of several months without methotrexate, but that the drug may have to be reintroduced at any time. No clear criteria have been established regarding omalizumab, although some personal experiences seems to show that at least some patients may not tolerate omalizumab withdrawal.…”

Section: Discussionmentioning

confidence: 99%

“…However, patients who require frequent or continuous oral corticosteroid administration have received little attention. Due to the severe side effects of steroids when administered over long periods or at high doses, a great deal of effort has been devoted to the search for a possible corticosteroid sparing agent, and many drugs have been assessed to date 9 . The update of the Global Initiative for Asthma Treatment (GINA) report 3 in November 2006 offered for the first time an alternative to oral corticosteroids in patients included in step V (the most severe step).…”

Section: Introductionmentioning

confidence: 99%

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Omalizumab in the management of oral corticosteroid-dependent IGE-mediated asthma patients

Domingo

Moreno

Amengual

et al. 2010

Current Medical Research and Opinion

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Omalizumab in the management of oral corticosteroid-dependent IGE-mediated asthma patients

Domingo

Moreno

Amengual

et al. 2010

Current Medical Research and Opinion

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“…354,418 Besides sarcoidosis, RCTs have suggested a role for methotrexate as a steroid-sparing agent in chronic asthma. 419,420 Positive effects in open-label trials have also been reported in granulomatosis with polyangiitis for induction of remission in non-life-threatening disease 352,421 or for maintenance of remission after induction with cyclophosphamide. 422 There are also reports of benefi cial effects for cryptogenic organizing pneumonia, 423 polymyositis-dermatomyositis-associated ILD, 424 Churg-Strauss syndrome, 425 and steroidresistant lung allograft rejection.…”

Section: Methotrexatementioning

confidence: 99%

Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

Baughman

Meyer

Nathanson

et al. 2012

Chest

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Objectives: Immunosuppressive pharmacologic agents prescribed to patients with diffuse interstitial and infl ammatory lung disease and lung transplant recipients are associated with potential risks for adverse reactions. Strategies for minimizing such risks include administering these drugs according to established, safe protocols; monitoring to detect manifestations of toxicity; and patient education. Hence, an evidence-based guideline for physicians can improve safety and optimize the likelihood of a successful outcome. To maximize the likelihood that these agents will be used safely, the American College of Chest Physicians established a committee to examine the clinical evidence for the administration and monitoring of immunosuppressive drugs (with the exception of corticosteroids) to identify associated toxicities associated with each drug and appropriate protocols for monitoring these agents. Methods: Committee members developed and refi ned a series of questions about toxicities of immunosuppressives and current approaches to administration and monitoring. A systematic review was carried out by the American College of Chest Physicians. Committee members were supplied with this information and created this evidence-based guideline. Conclusions: It is hoped that these guidelines will improve patient safety when immunosuppressive drugs are given to lung transplant recipients and to patients with diffuse interstitial lung disease. CHEST 2012; 142(5):e1S-e111SAbbreviations: ACCP 5 American College of Chest Physicians; ALT 5 alanine aminotransferase; ATG 5 antithymocyte globulin; CHF 5 congestive heart failure; CMV 5 cytomegalovirus; CNI 5 calcineurin inhibitor; COI 5 confl ict of interest; CsA 5 cyclosporin A; FDA 5 US Food and Drug Administration; HBV 5 hepatitis B virus; HMG-CoA 5 b -hydroxy-bmethylglutaryl-coenzyme A; HSP 5 Health and Science Policy Committee; IL2RA 5 IL-2 receptor a ; ILD 5 interstitial lung disease; IPF 5 idiopathic pulmonary fi brosis; ITP 5 idiopathic thrombocytopenia purpura; LAM 5 lymphangioleiomyomatosis; MESNA 5 sodium 2-sulfonylethanesufonate; MPA 5 mycophenolic acid; mTOR 5 mammalian target of rapamycin; PTLD 5 posttransplant lymphoproliferative disease; RCT 5 randomized controlled trial; SIRS 5 systemic infl ammatory response syndrome; TNF 5 tumor necrosis factor; TPMT 5 thiopurine methyltransferase

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“…cyclosporine or methotrexate have only marginal additive effect. However, where control is difficult despite high dose systemic steroids or when adverse effects of systemic steroids become intolerable, these drugs may prove to have some steroid sparing effect [81]. Adverse effect monitoring is crucial.…”

Section: Managementmentioning

confidence: 99%

“…Adverse effect monitoring is crucial. Methotrexate is given once weekly and close monitoring of blood count is essential [81,82]. With cyclosporine, it important to closely monitor blood pressure and renal function.…”

Section: Managementmentioning

confidence: 99%

Brittle Asthma

Haqqee¹,

Arshad²

2007

CRMR

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About 5% of asthmatics do not behave like 'classical' asthmatics and may not respond adequately to conventional therapy. The terms used to describe such non-responders include severe, refractory, near fatal, difficult and difficult to control asthma. Within the umbrella term of severe or refectory asthma, there are distinct sub-phenotypes including brittle asthma. Brittle asthma is rare and may occur in 0.05% of all asthmatics. Currently the diagnosis of brittle asthma is made on clinical grounds based on the variability of peak flow and uncertainty and unpredictability of sudden onset of disabling and severe symptoms despite maximal medical therapy with high dose inhaled corticosteroids, inhaled and nebulised bronchodilators and either maintenance or repeated courses of systemic corticosteroids.The role of genetics, environmental exposure and infection is the focus of ongoing research in the development of severe asthma. Atopy, female sex and psychosocial factors are recognised to be associated with brittle asthma. Other factors, investigated as possible initiating or contributing factors in brittle asthma include nutrient deficiency, reduced antioxidants activity and immunodeficiency with low IgG subclass levels.This review will highlight the related phenotypes, risk factors, mortality and morbidity, pathogenesis and management of patients with brittle asthma.

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Benefits of low weekly doses of methotrexate in steroid-dependent asthmatic patients. A double-blind, randomized, placebo-controlled study

Abstract: (1) Methotrexate is an effective steroid-sparing agent. (2) A dosage lower than the one recommended in the literature is effective. (3) Tolerance is good. (4) No benefit or detrimental effects in bone metabolism were observed after one year.

Cited by 35 publications

References 28 publications

Omalizumab in the management of oral corticosteroid-dependent IGE-mediated asthma patients

Omalizumab in the management of oral corticosteroid-dependent IGE-mediated asthma patients

Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

Brittle Asthma

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