Intervention Review

Methotrexate as a steroid sparing agent for asthma in adults

  1. Huw Richard H R Davies1,*,
  2. Leslie LG Olson2,
  3. Peter G Gibson3

Editorial Group: Cochrane Airways Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 31 JAN 2004

DOI: 10.1002/14651858.CD000391

Database Title

Additional Information

How to Cite

Davies HRHR, Olson LLG, Gibson PG. Methotrexate as a steroid sparing agent for asthma in adults. Cochrane Database of Systematic Reviews 1998, Issue 3. Art. No.: CD000391. DOI: 10.1002/14651858.CD000391.

Author Information

  1. 1

    Repatriation General Hospital, c/o Division of Medicine, Daw Park, South Australia, Australia

  2. 2

    John Hunter Hospital, Department of Respiratory Medicine, Hunter Region Mail Centre, N.S.W., Australia

  3. 3

    John Hunter Hospital, Department of Respiratory and Sleep Medicine, Hunter Mail Centre, NSW, Australia

*Huw Richard H R Davies, c/o Division of Medicine, Repatriation General Hospital, Daws Road, Daw Park, South Australia, 5041, Australia. huw.davies@rgh.sa.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Sustained oral corticosteroid use can lead to complications, so there is interest in identifying agents that can reduce oral steroid use in people with asthma. Methotrexate has attracted attention as a possible steroid sparing agent in patients with chronic oral steroid dependent asthma.

Objectives

The objective of this review was to assess the effects of adding methotrexate to oral corticosteroids in adults with stable asthma who are dependent on oral corticosteroids.

Search methods

The Cochrane Airways Group Specialised Register and reference lists of identified articles were searched. Searches are current as of February 2006.

Selection criteria

Randomised trials of the addition of methotrexate compared with placebo in adult steroid dependent asthmatics. Duration of therapy needed to be at least 12 weeks.

Data collection and analysis

Trial quality was assessed and data extraction was carried out by two reviewers independently. Study authors were contacted for missing information.

Main results

Ten trials involving a total of 185 people were included. Study design and quality, corticosteroid dosages and outcomes varied widely. There was a reduction in oral corticosteroid dose favouring methotrexate in parallel trials (weighted mean difference -4.1 mg per day, 95% confidence interval -6.8 to -1.3) and also in cross-over trials (weighted mean difference -2.9 mg per day, 95% confidence interval -5.9 to -0.2). There was no difference between methotrexate and placebo for forced expiratory volume in one minute (weighted mean difference 0.12 litre, 95% confidence interval -0.21 to 0.45). Hepatotoxicity was a common adverse effect with methotrexate compared to placebo (odds ratio 6.9, 95% confidence interval 3.1 to 15.5).

Authors' conclusions

Methotrexate may have a small steroid sparing effect in adults with asthma who are dependent on oral corticosteroids. However, the overall reduction in daily steroid use is probably not large enough to reduce steroid-induced adverse effects. This small potential to reduce the impact of steroid side-effects is probably insufficient to offset the adverse effects of methotrexate.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Methotrexate as a steroid sparing agent for asthma in adults

Some people with asthma need to rely on corticosteroid drugs to control their asthma. Corticosteroids reduce the inflammation (swelling) of the airways (passages to the lungs). Long-term use has serious adverse effects, so ways to try and cut down on the need for corticosteroids are sometimes tried. Methotrexate may also be able to reduce inflammation, and is sometimes used for arthritis. Its adverse effects include headaches, dizziness, fatigue and altered moods, and stomach, lung and liver complications. The review of trials found methotrexate provides little relief for asthma, and adds its own adverse effects.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以Methotrexate作為對成年氣喘病患的類固醇激發劑

持續使用口服類固醇會導致許多併發症,因此本文的主要目的在於探討何種藥劑能使氣喘病人減少服用類固醇. Methotrexate被認為可能是類固醇激發劑, 也就是說Methotrexate可能可使長期依賴口服類固醇的氣喘病人,減少類固醇的使用量.

目標

本篇文獻回顧的主要目的在於評估Methotrexate加入口服類固醇,對於病情穩定,但依賴口服類固醇的成年氣喘病人之療效.

搜尋策略

從Cochrane 呼吸道群組的文章進行搜尋, 同時查閱文獻的參考資料. 相關文獻查證進行到2006年2月.

選擇標準

比較隨機加入Methotrexate和安慰劑對類固醇依賴氣喘病人的影響.治療期間至少12周.

資料收集與分析

兩名審閱者各自獨立評估試驗品質及擷取資料.有缺失的資料則連絡作者.

主要結論

本次文獻回顧共納入10個試驗,包含185個病患.研究的設計與品質,以及類固醇的劑量和結果均有很大的不同.不論是平行試驗(weighted mean difference −4.1 mg per day, 95% confidence interval −6.8 to −1.3), 或是交叉試驗(weighted mean difference −2.9 mg per day, 95% confidence interval −5.9 to −0.2),加入methotrexate之後,口服類固醇的劑量均有減少的情況.一分鐘用力吐氣量(forced expiratory volume in one minute)在添加methotrexate及使用安慰劑的試驗並沒有差異.相較於安慰劑的使用, Methotrexate的肝毒性副作用較為普遍.

作者結論

對於依賴口服類固醇的成年氣喘患者而言, methotrexate具有些微的類固醇激發作用, 意即使用 methotrexate, 可稍微減少口服類固醇使用量.然而,每天減少的類固醇劑量,可能並不足以減少類固醇的副作用. 況且減少類固醇副作用的程度,可能不足於抵銷methotrexate的副作用.

翻譯人

本摘要由國泰綜合醫院劉怡敏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在嚴重氣喘病人,加入methotrexate以減低類固醇用量,可能會增加methotrexate的副作用.有些氣喘病人須依賴類固醇以控制氣喘.類固醇可降低呼吸道的發炎情形.長期使用類固醇會有嚴重的副作用,所以試著減少類固醇的需求. Methotrexate也是可以減少發炎情形,所以有時被用來治療關節炎.它的副作用包括頭痛,暈眩,疲倦及心情改變,同時有胃,肺及肝的副作用.本篇文獻回顧發現Methotrexate雖可稍微緩解氣喘的發作,但卻增加它的副作用.

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