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Methotrexate in steroid-dependent asthma: long-term results
R J Shiner1, I Katz, T Shulimzon
1Department of Clinical Respiratory Physiology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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.
Insights
Methotrexate (MTX) effectively reduces steroid dependence in most asthma patients. This long-term study shows MTX is safe and efficacious, with manageable side effects for steroid-dependent asthma.
Area of Science:
- Pulmonology
- Immunology
- Pharmacology
Background:
- Steroid-dependent asthma requires long-term systemic corticosteroid therapy.
- Systemic corticosteroids are associated with significant side effects.
- Alternative steroid-sparing agents are needed for managing severe asthma.
Purpose of the Study:
- To evaluate the efficacy and safety of methotrexate (MTX) as a steroid-sparing agent in patients with steroid-dependent asthma.
- To assess the long-term outcomes of MTX treatment in this patient population.
Main Methods:
- Prospective evaluation of 21 steroid-dependent asthmatic patients receiving 15 mg of MTX weekly.
- Patients were followed for a mean of 14.7 months.
- Assessed changes in systemic steroid dosage, liver function, and side effects.
Main Results:
- 13 out of 21 patients were weaned off all regular systemic steroids.
- Four patients achieved a ≥50% reduction in steroid dose, and four had <50% reduction.
- Abnormal liver function tests occurred in 6 patients, resolving in 5 despite MTX continuation. Gastrointestinal side effects were reported in 6 patients, resolving in 5 with intramuscular MTX. No hematologic or pulmonary complications were observed.
Conclusions:
- Methotrexate (MTX) is a safe and effective steroid-sparing agent for most patients with steroid-dependent asthma.
- Long-term treatment with MTX can lead to significant reductions in systemic corticosteroid use.
- MTX offers a viable therapeutic option with manageable side effects for severe asthma management.