Objective: To evaluate the efficiency of low doses of methotrexate as corticosteroid sparing agent in asthmatic patients requiring long term corticosteroid therapy.
Methods: A prospective study was conducted with seven adult patients and one female pediatric patient suffering from corticosteroid-dependent bronchial asthma. The minimal stabilization time for each patient before initiating treatment with MTX was 3 months. The administered dose of methotrexate was 10 mg/week p.o. for adult patients and 15 mg/week for the pediatric patient. Dose tapering of methyl-prednisolone both during the stabilization and therapy periods was a 2 mg decrease every two weeks provided that no worsening in FEV1 higher than 5% occurred.
Results: For the group of adult patients, the stabilization time was 5.6 +/- 2.7 months. Methyl-prednisolone dose during the stabilization period could be decreased from 15.0 mg down to 25.4 +/- 12.0 mg (p = 0.013). The period of treatment of methotrexate was 7.3 +/- 3.4 months and the dose of methyl-prednisolone could be decreased from 25.4 +/- 12.0 mg down to 12.0 +/- 11.9 mg (p < 0.001). In the pediatric patient, the deflazacor dose was decreased from 60 down to 30 mg/day during treatment with methotrexate. In all patients a significant decrease could be obtained in the MP dose during treatment with methotrexate with no decrease in FEV1. No secondary effects were observed with the exception of a labial herpes in the pediatric patient.
Conclusions: The administration of one single weekly dose of methotrexate 10 mg in adults and 15 in one pediatric patient allowed for a decrease of approximately 50% in the glucocorticosteroid dosage in this group of patients with corticosteroid-dependent bronchial asthma with no relevant adverse reactions during therapy.