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Long-term methotrexate treatment in corticosteroid-dependent asthma
M F Mullarkey1, J K Lammert, B A Blumenstein
1Virginia Mason Clinic, Seattle, Washington.
Annals of Internal Medicine
|April 15, 1990
Summary
Low-dose methotrexate effectively reduces corticosteroid dependence in severe asthma patients. This safe adjunctive therapy improves lung function and symptoms, allowing for significant prednisone dose reduction.
Area of Science:
- Pulmonology
- Pharmacology
- Clinical Medicine
Background:
- Corticosteroid-dependent bronchial asthma requires long-term management.
- Patients often struggle to reduce prednisone dosage despite maximal conventional therapies.
- Identifying effective corticosteroid-sparing agents is crucial for managing severe asthma.
Purpose of the Study:
- To evaluate the long-term efficacy of low-dose methotrexate as a corticosteroid-sparing agent.
- To assess the safety and toxicity profile of methotrexate in this patient population.
- To determine the impact on prednisone dosage and asthma symptom control.
Main Methods:
- A prospective case series design was employed.
- 31 patients with corticosteroid-dependent asthma, requiring daily prednisone, were included.
- 25 patients completed 18-28 months of low-dose methotrexate (15-50 mg/wk) therapy.
Main Results:
- The mean prednisone dose significantly decreased from 26.9 mg/d to 6.3 mg/d (P=0.0001).
- 15 patients discontinued prednisone, 9 reduced use by >50%, and lung function (FEV1) improved.
- Mild adverse drug reactions occurred in 15 patients but did not necessitate treatment discontinuation.
Conclusions:
- Low-dose methotrexate is an effective and safe long-term corticosteroid-sparing agent for severe bronchial asthma.
- Methotrexate therapy leads to significant reductions in prednisone requirements.
- Adjunctive methotrexate improves asthma control and lung function with a favorable safety profile.
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