THE ROLE OF METHOTREXATE IN THE MANAGEMENT OF STEROID-DEPENDENT ASTHMA

Severe asthma often requires high-dose corticosteroid therapy. However , steroid therapy is fraught with many side effects. There are conflic ting reports in the literature regarding the role of methotrexate in r educing the steroid requirements of these patients. This study examine d the role of low-dose methotrexate in the management of steroid-depen dent asthma. Eleven subjects with stable steroid-dependent asthma were enrolled in a placebo-controlled double-blind crossover trial. Patien ts received methotrexate, 15 mg/wk, or placebo each for two 12-week pe riods. There was significant improvement of pulmonary function and red uction of prednisone requirement in both placebo and methotrexate trea tment periods. However, methotrexate was not superior to placebo. Only 3 of 11 patients responded to methotrexate. Although low-dose methotr exate therapy may have a role in a small select group of steroid-depen dent asthmatics, it provided no additional benefit overall.