Low-dose methotrexate in the management of Chinese patients with steroid-dependent asthma

Nine Chinese patients with severe asthma who were dependent on a systemic oral steroid for control were given oral methotrexate at a dose of 7.5 mg on alternate days for two weeks, followed by 15 mg once weekly. Only six patients were evaluable; they had received methotrexate for 6 to 24 months. All six patients could have reduction of daily oral prednisolone dosage by 5-15 mg (mean: 10.4 mg). Only four patients, however, had > or = 15% improvement of their best peak expiratory flow rates compared with baseline levels, though all six patients had symptomatic improvement. These beneficial effects were, however, transient and persisted only during methotrexate therapy. Four patients had liver enzyme changes and discontinuation of therapy was required in one patient. One patient also had infective spondylitis secondary to Salmonella bacteremia. Thus low-dose oral methotrexate may be useful in selected patients with severe steroid-dependent asthma with careful monitoring for response and drug toxicity.