METHOTREXATE IN THE TREATMENT OF ASTHMA - AN OPEN STUDY OF 10 SEVERE STEROID-DEPENDENT ASTHMATICS

Methotrexate was suggested as a treatment in 1976 by Mullarkey for sev ere steroid-dependent asthma, in order to reduce the use of systemic s teroids responsible for numerous undesired side-effects. The aim of th is open trial was to study the efficacy and tolerance of Methotrexate in the short, medium and long term and after its cessation, in ten pat ients aged 49.2 (+/- 3.0) who were suffering from severe steroid-depen dent asthma (18.5 +/- 4.8 mg of prednisone daily for at least one year ). Methotrexate was given in a dose of 15-30 mg for 14.3 months (+/-1. 8) with a post-treatment follow-up for eight patients lasting 7.9 mont hs (+/-1.7). The efficacy was assessed on the daily dosage of predniso ne and was also evaluated using the FEV1 (VEMS) (the variations expres sed were a percentage of the variation from the predicted value). In t he short term (six weeks) there was no significant change in the FEV1 nor in the dose of prednisone. In the medium term (12 weeks) there was evidence of a reduction in the average daily dosage of prednisone of 39.5% with an increase in the FEV1 of 14.1%. In the long term MTX was not found as effective in reducing the dose of prednisone (15.2 mg) as on the FEV1 (an increase of 5.1% on the theorical values). There was a favourable outcome for two patients who maintained the benefit after stopping the MTX. Seven out of ten patients presented with side effec ts of MTX, in three of whom the drug has to be stopped. In conclusion, only two out of ten patients were improved by MTX. New trials should be directed at showing the predictive characteristics of response to M TX which would enable more precise indications for their use in severe asthma.