Summary
The inflammatory process underlying bronchial asthma is well established and has prompted clinical interest in nonsteroidal anti-inflammatory forms of treatment. Although unproven, it has been suggested that effective treatment of allergic inflammation may prevent long term consequences of asthma and avert deterioration in pulmonary function. Methotrexate has potent anti-inflammatory actions, even at low doses, and was judged to be a suitable candidate drug for asthma treatment if it could demonstrate an acceptable tolerability profile. Low dose methotrexate has been investigated in both noncomparative studies and in placebo-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. Rare but potentially life-threatening adverse effects involving the pulmonary, hepatic and haematological systems remain of particular concern.
Methotrexate should therefore be considered as an adjunct to high dose 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 physicians with experience in the use of the drug, and the relevant safety parameters should be closely monitored.
Similar content being viewed by others
References
Bardin PG, Johnston SC, Holgate ST. Anti-inflammatory strategies for the treatment of asthma. South African Medical Journal 81: 303–309, 1992
Calderon E, Coffey RG, Lockey RF. Methotrexate in bronchial asthma. Journal of Allergy and Clinical Immunology 88: 274–276, 1991
Dyer DP, Vaughan TR, Weber RW. Methotrexate in the treatment of steroid-dependent asthma. Journal of Allergy and Clinical Immunology 88: 208–212, 1991
Erzurum SC, Leff JA, Cochran JE, Ackerson LM, Szefler SJ, et al. Lack of benefit of methotrexate in severe, steroid-dependant asthma. Annals of Internal Medicine 114: 353–360, 1991
Evans WE, Christensen ML. Drug interactions with methotrexate. Journal of Rheumatology 12: 15–18, 1985
Gilbert SC, Klintmalm G, Menter A. Methotrexate induced cirrhosis requiring liver transplantation in 3 patients with psoriasis. Archives of Internal Medicine 150: 889–891, 1990
Guss S, Portnoy J. Methotrexate treatment of severe asthma in children. Pediatrics 89: 635–639, 1992
Jones G, Murius E, Karsh J. Methotrexate induced asthma. American Review of Respiratory Disease 143: 179–181, 1991
Kuitert LM, Harrison AC, Pneumocystis carinii pneumonia as a complication of methotrexate treatment of asthma. Thorax 46: 936–937, 1991
Mullarkey MF. Methotrexate and asthma. Journal of Allergy and Clinical Immunology 88: 272–274, 1991
Mullarkey MF, Blumenstein BA, Andrade WP, Bailey GA, Olason I, et al. Methotrexate in the treatment of corticosteroid dependent asthma: a double-blind crossover study. New England Journal of Medicine 318: 603–607, 1988
Mullarkey MF, Lammert JK, Blumenstein BA. Long term methotrexate treatment in corticosteroid dependent asthma. Annals of Internal Medicine 112: 577–581, 1990
Mullarkey MF, Webb D, Pardee NE. Methotrexate in the treatment of steroid-dependent asthma. Annals of Allergy 56: 347–350, 1986
Roenigh HH, Auerbach R, Maibach HI. Methotrexate in psoriasis — revised guide-lines. Journal of American Academy of Dermatology 19: 145–146, 1988
Segal R, Mozes E, Yarom M. The effects of methotrexate on the production and activity of interleukin-1. Arthritis and Rheumatism 32: 370–376, 1989
Shiner RJ, Nunn AJ, Chung KF, Geddes DM. Steroid-sparing effect of methotrexate in the treatment of chronic severe asthma: a double-blind controlled study. Lancet 336: 137–140, 1990
Steinberg AD. An approach to the use of immunosuppressive drugs in nonmalignant diseases. Journal of Allergy and Clinical Immunology 52: 242–250, 1973
Stempel DA, Lammert J, Mullarkey MF. Use of Methotrexate in the treatment of steroid-dependent adolescent asthmatics. Annals of Allergy 67: 346–348, 1991
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bardin, P.G., Fraenkel, D.J. & Beasley, R.W. Methotrexate in Asthma. Drug-Safety 9, 151–155 (1993). https://doi.org/10.2165/00002018-199309030-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-199309030-00002