1 Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK.
2 Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
Chron Respir Dis. 2018 Feb;15(1):85-87. doi: 10.1177/1479972317709650. Epub 2017 Jun 1.
The use of oral methotrexate for refractory eosinophilic asthma in a tertiary asthma referral centre, Glenfield Hospital, Leicester, was evaluated between January 2006 and December 2014. The patients ( n = 61) were carefully phenotyped at baseline with markers of airway inflammation. In addition, a structured oral methotrexate proforma was utilized to evaluate response to therapy and adverse events. Oral steroid withdrawal was attempted 3 months after commencing treatment. Several outcomes were evaluated at 12 months, including both efficacy and adverse effects; 15% ( n = 9/61) responded by achieving a decrease in daily oral corticosteroid dose (mean 8.43 (±8.76) mg), although we were unable to identify factors that predicted a treatment response. There were no other significant changes in any other clinical outcome measures. There was a high rate of adverse events (19/61 (31%)), primarily gastrointestinal/hepatitis. Our findings support the use of biological agents in preference to using oral methotrexate as a steroid sparing agent at the first instance. In the event of failure of these agents, oral methotrexate remains a therapeutic option, which can be considered in highly specialist severe asthma centres.
在莱斯特的格伦菲尔德医院的一个三级哮喘转诊中心，我们评估了 2006 年 1 月至 2014 年 12 月期间，口服甲氨蝶呤治疗难治性嗜酸性粒细胞性哮喘的效果。这些患者（n=61）在基线时进行了仔细的表型分析，以确定气道炎症的标志物。此外，我们还使用了一种结构化的口服甲氨蝶呤方案，以评估治疗反应和不良反应。在开始治疗后 3 个月尝试停用口服皮质类固醇。在 12 个月时评估了几个结果，包括疗效和不良反应；15%（n=9/61）通过减少每日口服皮质类固醇剂量（平均 8.43（±8.76）mg）来响应治疗，尽管我们无法确定预测治疗反应的因素。其他任何临床结果测量都没有显著变化。不良反应发生率很高（19/61（31%）），主要是胃肠道/肝炎。我们的研究结果支持在一线治疗中使用生物制剂，而不是使用口服甲氨蝶呤作为皮质类固醇节约剂。在这些药物治疗失败的情况下，口服甲氨蝶呤仍然是一种治疗选择，可以在高度专业的严重哮喘中心考虑。
