LOW-DOSE METHOTREXATE IN THE MANAGEMENT OF CHINESE PATIENTS WITH STEROID-DEPENDENT ASTHMA

Nine Chinese patients with severe asthma who were dependent on a syste mic 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 p rednisolone dosage by 5-15 mg (mean: 10.4 mg). Only four patients, how ever, had greater than or equal to 15% improvement of their best peak expiratory flow rates compared with baseline levels, though all six pa tients had symptomatic improvement. These beneficial effects were, how ever, transient and persisted only during methotrexate therapy. Four p atients had liver enzyme changes and discontinuation of therapy was re quired in one patient. One patient also had infective spondylitis seco ndary 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.