METHOTREXATE IN STEROID-DEPENDENT ASTHMA - LONG-TERM RESULTS

Treatment of 21 steroid-dependent asthmatic patients with methotrexate (MTX) 15 mg/week was prospectively evaluated for a mean of 14.7 (SD 3 .7) months. Before MTX, therapy consisted of a mean prednisone dose of 16.6 (SD 9.2) mg, in addition to inhaled beclomethasone/budesonide (m ean daily dose 1157 (SD 330) mu g) and bronchodilators. Thirteen patie nts were weaned from all regular systemic steroid therapy, a 50% or mo re reduction was achieved in four patients, and a less than 50% reduct ion in four patients. Abnormal liver function tests were noted in six of the 21 patients; this resolved despite continuation of MTX in five. In one patient, MTX was stopped because of symptoms as well as a five fold rise in serum transaminases, and a speedy resolution was noted. G astrointestinal side-effects were reported in six patients but were re solved in five with intramuscular MTX. There were no hematologic or pu lmonary complications. We conclude that MTX appears to be both safe an d efficacious as a steroid-sparing agent in most steroid-dependent ast hmatic patients when taken over a long period.