METHOTREXATE IN ASTHMA - A SAFETY PERSPECTIVE

The inflammatory process underlying bronchial asthma is well establish ed and has prompted clinical interest in nonsteroidal anti-inflammator y forms of treatment. Although unproven, it has been suggested that ef fective treatment of allergic inflammation may prevent long term conse quences of asthma and avert deterioration in pulmonary function. Metho trexate has potent anti-inflammatory actions, even at low doses, and w as judged to be a suitable candidate drug for asthma treatment if it c ould demonstrate an acceptable tolerability profile. Low dose methotre xate has been investigated in both noncomparative studies and in place bo-controlled studies of severe asthma. In general, such studies have suggested that methotrexate may have steroid-sparing benefits coupled to generally mild adverse events; although adverse effects were not of a serious nature they were observed in up to one-third of patients. R are but potentially life-threatening adverse effects involving the pul monary, hepatic and haematological systems remain of particular concer n. Methotrexate should therefore be considered as an adjunct to high d ose inhaled corticosteroids in patients who require more than 10mg of prednisolone daily, and who experience severe and unacceptable steroid -related adverse effects. Treatment should only be initiated by physic ians with experience in the use of the drug, and the relevant safety p arameters should be closely monitored.