Drug Safety

, Volume 15, Issue 4, pp 283–290 | Cite as

A Risk-Benefit Assessment of Methotrexate in Corticosteroid-Dependent Asthma

  • Tiberiu R. Shulimzon
  • Robert J. Shiner
Review Article Risk-Benefit Assessment

Summary

Methotrexate is a folic acid antagonist with proven anti-inflammatory properties. This originally led to its use in the therapy of some rheumatic and dermatological inflammatory disorders and, since the early 1980s, as a corticosteroid-sparing agent in the therapy of bronchial asthma.

Although the exact anti-inflammatory mechanism is not known, it appears that in some patients with severe corticosteroid-dependent bronchial asthma, a reduction of at least 50% in the maintenance corticosteroid dosage can be achieved.

Controversies regarding methotrexate efficacy may be a result of the small size and heterogeneity of the patient populations studied and the variable definition of corticosteroid ‘dependence’.

Although the potential for serious short and long term adverse effects resulting from methotrexate therapy cannot be ignored, overall, methotrexate appears to be well tolerated at low dosages. Hepatic and pulmonary toxicity are the main adverse effects of concern.

The ‘lesser evil’ approach is logical, but it is imperative to administer the drug for at least 3 months to adequately assess its efficacy in a specific patient.

Keywords

Asthma Methotrexate Allergy Clin Immunol Peak Expiratory Flow Rate Methotrexate Therapy 

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Copyright information

© Adis International Limited 1996

Authors and Affiliations

  • Tiberiu R. Shulimzon
    • 1
    • 2
  • Robert J. Shiner
    • 1
    • 2
  1. 1.Department of Clinical Respiratory PhysiologyInstitute of Respiratory Medicine, The Chaim Sheba Medical CenterTel HashomerIsrael
  2. 2.Sackler School of MedicineTel-Aviv UniversityIsrael

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