Ge. Stewart et al., COMPARISON OF ORAL PULSE METHOTREXATE WITH PLACEBO IN THE TREATMENT OF SEVERE GLUCOCORTICOSTEROID-DEPENDENT ASTHMA, Journal of allergy and clinical immunology, 94(3), 1994, pp. 482-489
Background: This study compared the efficacy of weekly oral administra
tion of methotrexate and placebo in treatment of 24 subjects with chro
nic glucocorticosteroid-dependent asthma. Methods: The 33-week randomi
zed, double-blind, placebo-controlled crossover trial compared once we
ekly 15 mg doses of methotrexate with placebo. At the time of entry th
e subjects' mean dosage of prednisone was 23.8 mg/day (range, 12.5 to
85 mg) and glucocorticosteroid therapy had been used continuously for
a mean duration of 78 months (range, 5 to 360 months). Results: Of the
21 subjects who completed the study, 13 tolerated lower daily prednis
one doses during methotrexate treatment compared with placebo. When tr
eated with methotrexate, subjects required 14.2% less prednisone than
when treated with placebo (p = 0.0447), their subjective symptom score
s improved 21.4% (p < 0.05), and mean forced expiratory volume in 1 se
cond values tended to improve. Mean serum theophylline levels did not
change significantly between the methotrexate and placebo arms of the
study. Adverse effects were minimal, with nausea and headache occurrin
g twice as often during methotrexate therapy compared with placebo. Co
nclusion: Short-term, low-dose, pulse therapy with orally administered
methotrexate results in a decrease in the daily glucocorticosteroid r
equirement in a majority of subjects with severe asthma and is accompa
nied by improvement in subjective symptom scores without unacceptable
side effects or deterioration of pulmonary function.