Methotrexate in steroid‐dependent asthma: long‐term results

Abstract

Treatment of 21 steroid-dependent asthmatic patients with methotrexate (MTX) 15 mg/week was prospectively evaluated for a mean of 14.7 (SD 3.7) months. Before MTX, therapy consisted of a mean prednisone dose of 16.6 (SD 9.2) mg, in addition to inhaled beclomethasone/budesonide (mean daily dose 1157 (SD 330) micrograms) and bronchodilators. Thirteen patients were weaned from all regular systemic steroid therapy, a 50% or more reduction was achieved in four patients, and a less than 50% reduction in four patients. Abnormal liver function tests were noted in six of the 21 patients; this resolved despite continuation of MTX in five. In one patient, MTX was stopped because of symptoms as well as a fivefold rise in serum transaminases, and a speedy resolution was noted. Gastrointestinal side-effects were reported in six patients but were resolved in five with intramuscular MTX. There were no hematologic or pulmonary complications. We conclude that MTX appears to be both safe and efficacious as a steroid-sparing agent in most steroid-dependent asthmatic patients when taken over a long period.

Low-dose methotrexate treatment in severe glucocorticoid-dependent asthma: effect on mucosal inflammation and in vitro sensitivity to glucocorticoids of mitogen-induced T-cell proliferation

“…However, in asthma adenosine is a potent bronchoconstrictor probably due to activation of mast cells via A2-receptors [35]. In clinical trials conducted so far [11], the absence of reduced, and incidentally even increased, bronchial hyperresponsiveness following MTX treatment might be associated with increased release of adenosine, and explain the clinical deterioration observed in this patient. This raises the possibility that the final outcome of MTX treatment in glucocorticoid-dependent asthmatics, therefore, may depend on the balance between improved responsiveness to the suppressive action of glucocorticoids and the degree of MTX-induced autocoid release.…”

“…A number of open studies has suggested clinical efficacy of MTX [10,11]. This has been confirmed in doubleblind placebo-controlled trials [12,13].…”

Inflammatory bowel disease: The asthma of the intestine?

“…When steroids cannot be withdrawn or do not induce remission in both asthma and IBD, antimetabolites or immunosuppressive agents such as methotrexate (128)(129)(130)(131)(132)(133)(134)(135)(136)(137)(138)(139)(140)(141)(142)(143) and azathioprine/6-mercaptopurine (6-MP) (144) are used. Methotrexate may have an important inhibitory effect on cytokine synthesis and activity.…”

A Risk-Benefit Assessment of Methotrexate in Corticosteroid-Dependent Asthma

“…[21] 21 patients corticosteroiddependent asthma were treated with methotrexate IS mg/ week over a mean period of 14.3 months. 13 of the 21 patients were completely weaned from all regular systemic corticosteroid therapy and a greater than 50% reduction in systemic corticosteroid dosage was noted in another 4 patients.…”