Methotrexate: Does It Treat or Induce Asthma?

Fertel, Debra; Wanner, A.

doi:10.1164/ajrccm/143.1.1

Cited by 19 publications

(3 citation statements)

References 4 publications

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“…However, its efficacy remains controversial [27]. The question emerged whether MTX treats or induces asthma [28]. In analogy, the question can be added whether MTX diminishes airways inflammation associated with bronchial narrowing and hyper-reactivity in RA or causes drug-induced airflow obstruction.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Function in Rheumatoid Arthritis Treated With Low-Dose Methotrexate: A Longitudinal Study

et al. 1996

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SUMMARYLung volumes and gas exchange were investigated prospectively in 96 patients with rheumatoid arthritis selected without regard to pulmonary disorders and treated with i.m. methotrexate (MTX) injections [mean weekly dose 13.0 mg (5th-95th percentile (5-95 PC) 7.6-20.8)]. Individual changes over time during MTX treatment [mean duration 2.9 yr (5-95 PC 0.4-5.3)] were assessed by regression analyses in each individual. Forced vital capacity (FVQ remained stable in the majority of patients [mean annual change +0.8% (5-95 PC -8.1 to +14.0) of calculated normal value]. In addition, transfer factor using the indicator gas CO (Tuco) was unaltered in most patients [mean annual change -2.1% (5-95 PC -16.2 to +11.8) of predicted value]. However, there were significant decreases in the forced expiratory volume in 1 s (FEV,) before and after inhalation of 0.2 mg salbutamol [mean annual change -0.8% (5-95 PC -8.4 to +3.2) and -1.3% (5-95 PC -7.8 to +3.9) of the FVC measured, respectively]. In addition, there were significant increases in alveolar-arterial Po, gradients (P(A-.W)J) at rest and after exercise [mean annual change +1.7 mmHg (5-95 PC -5.2 to +12.2) and +1.8 mmHg (5-95 PC -3.5 to 9.0), respectively]. Nevertheless, the amounts were small in view of the reliability of the methods applied and reflect, at least in part, the normal process of ageing. The annual change in FEVi/FVC was negatively correlated with FEV,/FVC at baseline (R, = -0.46, P < 0.001). The annual change in T U co was also negatively correlated with Ti^o at baseline (Rs = -0.31, P = 0.028). No other risk factors for deterioration of lung volumes or gas exchange were found, including mean weekly MTX dose, age, gender, smoking, presence of rheumatoid factor and pulmonary function at baseline. We conclude that MTX has no major effect on pulmonary function in the majority of patients and that there is no evidence that patients with pre-existing pulmonary disease are at increased risk for further deterioration of lung function.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Function in Rheumatoid Arthritis Treated With Low-Dose Methotrexate: A Longitudinal Study

et al. 1996

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“…In an editorial published in 1991, Fertel and Wanner [32] addressed the studies of Mullarkey and co-workers[IO. 19,20] and cast doubt on the necessity of using methotrexate in all patients with asthma who were dependent on systemic corticosteroids.…”

Section: Negative Resultsmentioning

confidence: 99%

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

Shulimzon

Shiner

1996

Drug Safety

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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.

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“…The most recent concern is that methotrexate may actually cause asthma and increase bronchial hyperresponsiveness [15,16]. A single patient with rheumatoid arthritis developed asthma while taking methotrexate and improved on stopping the drug.…”

Section: Role In Therapymentioning

confidence: 99%

Methotrexate in asthma

Geddes

1991

Clin Experimental Allergy

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Methotrexate: Does It Treat or Induce Asthma?

Cited by 19 publications

References 4 publications

Pulmonary Function in Rheumatoid Arthritis Treated With Low-Dose Methotrexate: A Longitudinal Study

Pulmonary Function in Rheumatoid Arthritis Treated With Low-Dose Methotrexate: A Longitudinal Study

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

Methotrexate in asthma

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