0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Lack of Benefit of Methotrexate in Severe, Steroid-Dependent Asthma: A Double-Blind, Placebo-Controlled Study

Serpil C. Erzurum, MD; Jonathan A. Leff, MD; Judith Evans Cochran, RN; Lynn M. Ackerson, PhD; Stanley J. Szefler, MD; Richard J. Martin, MD; and Gary R. Cott, MD
[+] Article and Author Information

Grant Support: By a Clinical Investigative Grant from the National Jewish Center for Immunology and Respiratory Medicine, Denver, Colorado, and by grants HL-07085 and HL-36577 from the National Institutes of Health.

Requests for Reprints: Gary R. Cott, MD, Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, 1400 Jackson Street, Room K613, Denver, CO 80206.

Current Author Addresses: Dr. Erzurum: National Institutes of Health, National Heart, Lung and Blood Institute, Pulmonary Branch, Building 10, Room 6014, Bethesda, MD 20892.

Drs. Leff, Martin, and Cott, and Ms. Cochran: Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.

Dr. Ackerson: Department of Biostatistics, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.

Dr. Szefler: Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.


© 1991 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1991;114(5):353-360. doi:10.7326/0003-4819-114-5-353
Text Size: A A A

Objective: To determine the effect of low-dose methotrexate in asthmatic patients on steroid use, asthma symptom scores, pulmonary function, airway reactivity, blood cellular components, and immunoglobulin E levels.

Design: A randomized, double-blind, parallel, placebocontrolled, 13-week clinical trial with follow-up of patients in an open trial of methotrexate at the conclusion of the double-blind study.

Setting: An asthma care outpatient clinic.

Patients: From February 1988 to March 1990, 19 patients with severe, steroid-dependent asthma were enrolled in the study. Two of these patients were excluded from analysis.

Interventions: Patients were administered methotrexate or placebo intramuscularly, to assure complete absorption, once weekly during the 13-week study.

Results: Patients on methotrexate and placebo both significantly decreased their steroid dose by 39.6% (95% CI, 25.1% to 54.1%, P = 0.001) and 40.2% (CI, 17.9% to 67.4%, P = 0.003), respectively. Pulmonary function did not differ significantly between the methotrexate and placebo groups. In addition, airway reactivity and symptom scores were unchanged on methotrexate or placebo. No significant toxicities were seen during the course of the 13-week blinded study, but one patient on methotrexate and prednisone in the follow-up period developed Pneumocystis carinii pneumonia and died. Despite continuing methotrexate for up to 1 year, and increasing methotrexate to 30 mg weekly, no significant benefit of methotrexate on asthma control could be shown.

Conclusion: Our study does not support the use of methotrexate in the treatment of severe asthma.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)