Methotrexate as a steroid sparing agent for asthma in adults

Davies, Huw Richard H R; Olson, Leslie Lg; Gibson, Peter G.

doi:10.1002/14651858.cd000391

Cited by 63 publications

(58 citation statements)

References 39 publications

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“…IgG, were studied as corticosteroid-sparing agents with the aim of reducing the dose of maintenance OCS. Although these agents may be considered to improve corticosteroid insensitivity, their efficacy is uncertain, and they are associated with significant side-effects (see GRADE question below) [179][180][181][182][183].…”

Section: Using Established Asthma Medications Corticosteroid Insensitmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

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Section: Using Established Asthma Medications Corticosteroid Insensitmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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“…Two metaanalyses of the steroid-sparing effect of low-dose methotrexate showed a small overall benefit but a relatively high frequency of adverse effects [128,129]. This small potential to reduce the impact of glucocorticosteroid side-effects is probably insufficient to offset the adverse effects of methotrexate [130]. Cyclosporin [131] and gold [132,133] have also been shown to be effective in some patients.…”

Section: Oral Anti-allergic Compoundsmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2007

Eur Respir J

2,664

2,301

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Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled ''A Global Strategy for Asthma Management and Prevention'', first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that ''it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,'' and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

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“…Therefore, tapering oral glucocorticosteroids to the lowest effective dose is of high priority [69]. Classical steroid sparing treatments including oral gold [71], methotrexate [72] and ciclosporin [73] have not gained acceptance because of limited effects and significant side-effects.…”

Section: Phenotype-specific Treatmentmentioning

confidence: 99%

Severe refractory asthma: an update

Wener

Bel

2013

Eur Respir Rev

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Asthma is a heterogeneous disease in which adequate asthma control cannot be achieved in a substantial proportion despite currently available treatment possibilities. This subgroup has been defined as ''severe refractory'' asthma. Over the past years considerable progress has been made regarding a more exact definition of severe refractory asthma. A systematic approach to evaluate the asthma patient has been postulated. Further detailed classification into distinct phenotypes is ongoing to target the right treatment to the right patient. And, new therapeutic targeted treatment options are currently in development to provide possible new targets to improve disease state, symptoms and quality of life. This review will provide an update on the latest advancements with regard to all these domains. @ERSpublications Phenotyping the severe asthma patient is essential to ensure the right treatment is given to the right patient

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Methotrexate as a steroid sparing agent for asthma in adults

Cited by 63 publications

References 39 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

Global strategy for asthma management and prevention: GINA executive summary

Severe refractory asthma: an update

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