[Long term and low dose treatment with methotrexate in corticosteroid-dependent asthma--two-year clinical experience]

Ten patients with corticosteroid-dependent asthma were treated with long-term and low dose methotrexate (MTX) for its corticosteroid-sparing effect. The average age was 51.2 years (ranged 24 to 67). Three were women. Despite the use of maximal doses of bronchodilators, their daily prednisolone dosages were always more than 10 mg during an average period of 2.75 years (ranged 1 to 6 years). Following the use of oral MTX, 15mg weekly from more than 6 months (averaged 11.8 months; ranged 6 to 15 months), the average daily requirement of prednisolone decreased from 14.5 to 6.5 mg (p < 0.01). Among them, four did not need steroid and the other six had a marked subjective improvement in breathing, cough and nocturnal dyspnea. However, three of them could not have steroid dose reduced. As for adverse reactions to MTX in ten patients, two patients had nausea and vomiting, two had skin eruption, three had somnolence, and one had elevated sGOT (78 U/L). The adverse effects were all transient. Neither oral ulcer, nor leukopenia was found among them. This study suggests long-term low dose oral MTX may have a steroid-sparing effect in steroid-dependent asthmatic patients. Their adverse effects were mild and transient.