SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

9/12/05

Weekly low dose methotrexate as a steroid-sparing therapy in chronic asthma

Summary
Background - A number of those with chronic severe asthma are dependent on systemic corticosteroid (CS) therapy. A number of agents have been studied as possible CS-sparing agents in such CS- dependent asthmatics.

Findings - Comet et al of the Hospital de Sabadell evaluated the efficacy and tolerance of 10 mg methotrexate (MTX) once weekly as a CS-sparing agent in a double blind, randomized, placebo-controlled trial in 46 CS-dependent chronic asthmatics. In an interim analysis carried out after one year in 39 patients, they found a 55% decrease in the dose of CS needed to maintain the baseline FEV-1 in those receiving MTX. In comparison, addition of placebo instead of MTX was followed by a very modest (4.4%) decrease in the CS dose needed. There was no significant change in the FEV-1 in the MTX and placebo groups which one would expect from the protocol in this study. Toxicity was occasional and mild in the MTX treatment group.

Reference
 Respir Med 2005; 8/12/05, E pub

Editor's Comments
There was an enthusiasm about 10-20 years ago for use of MTX as a CS sparing agent in CS- dependent asthma. However, some studies did not find a CS-sparing effect of MTX, possibly because of study design problems. There was also moderate toxicity associated with the larger doses of MTX employed. The considerably lower doses of MTX used in the current study (10 mg once a week) appears to be well tolerated while exerting CS dose-sparing effects.

 

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