CONTROLLED TRIAL OF METHOTREXATE IN PATIENTS WITH SEVERE CHRONIC ASTHMA

The aim of this study was to investigate the efficacy and adverse effe cts of methotrexate (MTX) in the treatment of severe chronic asthma in 12 patients with severe asthma requiring continuous treatment with or al steroids at the Outpatient Department of Helsinki University Centra l Hospital. The study was a randomised, double-blind placebo-controlle d trial of methotrexate treatment 15 mg weekly on a crossover basis ov er 24 weeks. During the 2 weeks baseline phase the mean dose of oral s teroids administered was 10.9 (3.2-28) mg . day(-1), and the mean dose of inhaled steroids administered was 2.3 (1.6-3.2) mg budesonide or b eclomethasone. The average dose of oral steroids administered was 12.8 mg . day(-1) during: the last 2 placebo weeks but only 7.9 mg . day(- 1) during the last 2 weeks with MTX treatment. The reduction in daily dose of oral steroids was 38%, while daily bronchodilator use was redu ced by 22%. During MTX treatment the patients experienced significantl y less wheezing, dyspnoea and coughing. Nine out of 12 patients report ed better asthma control during MTX treatment, The peak expiratory flo w rate (PEF) 1-s forced expiratory volume (FEV(1)) values did not diff er between MTX and placebo treatments, There was no statistical correl ation between serum MTX concentration and clinical improvement, No ser ious adverse effects of MTX were found during the study, It was conclu ded that low-dose MTX may be beneficial for severe chronic asthma and that this therapy is well tolerated by patients.