Mr. Asthma

Question:

 Hi Nancy,         I took methotrexate about 10 yrs. ago.  I had awful side effects.  It got to the point where I couldn’t walk, get out of bed, and just lying in bed hurt.  My knees, hips back, neck and head all ached and moving made it worse.  No change in asthma. For me it was poison. I hope that it helps you. Pam

Response:

Hi Nancy I take methotrexate once aweek.  I have been taking it off and on for 4 years.  Change of doctors caused the off and on.  Right now, I’m on it. I get blood work done every 6 months or sooner.  I’m not on oral steriods( made me deathly ill……last rites said over 10 times…) so now I’m on Pulmicort 2 puffs a day and a breathing machine.  Has it hlped I say yes.  I haven’t been in the hospital in over 4 years. ( The Pulmicort I just started 2 months ago.)                                  Lyssa

Response:

I took MTX for 1 year back in 94-95 and it successfully got me off long term use of predisone.  I too asked on this list for feedback from others taking MTX when I started it.  I’ll include the two response I got back then below.  The only side effect I had was a very very slight nausea most of the time. I know of others that have had bad experiences with MTX.  Some have had bad reactions to it so be sure to monitor yourself for any signs of respitory problem the first day you take it and get to the ER if you do. From the other posts it looks like there is much more info today than there was 5 years ago when treating asthma with MTX was just making its way out of research to the public. Hope all goes well with your use of MTX.   Technology Support Analyst, Principal   Information Technology   Arizona State University   BOX 870101                        PHONE  -  (602) 965-5663   Tempe, AZ  85287-0101     FAX  -  (602) 965-8698 Path: news.asu.edu!asuvax!cs.utexas.edu!math.ohio-state.edu!magnus.acs.ohio-state .edu! csn!news.sinet.slb.com!maggie.austin.wireline.slb.com!usenet Newsgroups: alt.support.asthma Organization: Pandora Project Lines: 80 Distribution: world NNTP-Posting-Host: asc144.austin.slcs.slb.com X-News-Reader: VMS NEWS v1.25 – Hide quoted text — Show quoted text – > I will starting to use Metrotrexate on Monday to see if my > Predinsone usage can be dropped/lowered.   The use of > Metrotrexate with asthmatics is just beginning to be more > open outside the testing/research setting.  Would be > interested in hearing from other asthmatic that have began > to use Metrotrexate. > Metrotrexate is an anti-inflammatory drug typicaly used with > people undergoing chemotherapy.  Asthmatics receiving this med > are typically given 1/10 the dose of the chemo patient.  There > has been some testing with a small group of asthmatics that > shows some good results but nothing large or long enough to > show pros and cons.  The side effects of Metrotrexate are far > less than those of Predinsone.

Hi!  I’m glad to share my own experience with Methotrexate.  I took the drug for almost three years in an effort to decrease my steroid dose.  I’ll list the good and bad stuff below.  MTX is not free of side effects by any means and is usually contemplated only for folks who are maxed out on the regular drugs and dependent on significant doses of oral steroids or who have severe complications from the ‘roids. one third. It reduced the number of hospitalizations for IV solu-medrol therapy, and it reduced slightly the hyper-reactivity of my airways.  My lung function did not improve while I was on the drug, but it did not deteriorate with the decreased pred dose. must have liver function tests done on a routine basis as well as CBCs (including platelets).  Currently the recommendation is that you also have a liver biopsy after every 1.0 to 1.5 gram of drug, so depending on how much you take each week, this could be every one or two years.  The reason this is recommended is that MTX can cause liver damage that does not always show up on the function tests. Arthritis patients have been treated with MTX for several years and I know folks were asking about changing the recommended biopsy, but as far as I know, it still stands.  Your blood count becomes abnormal while on the drug, but not dangerously so.  (It’s not normal on high doses of pred either).  Some very common side effects include nausea and headache. For me the nausea was chronic (i.e. all the time) and the headache was severe but manageable (see notes below).  All the biopsy results were fine too. MANAGEMENT NOTES:  When I started MTX therapy I had been on relatively high doses of steroid for several years (60-80 mg per day)and even then was not exactly under control.  I had been on another experimental therapy that almost killed me (but my lungs were working!) and was definitely maxed out on all the other meds.  My decision to start on the MTX was based on the fact that I was starting to suffer severe steroid complications and my quality of life was very poor.  I have wonderful pulmonologists who care for me and we went over all the pros and cons.  No one knows what the long term effects of methotrexate are, but it is a very potent drug…most chemo agents are. I was willing to gamble.  I got used to the nausea and in fact didn’t realize how much a part of me it was until I got off the drug.  I took MTX by injection, it worked better for me that way and I ended up taking slightly more of the drug than most asthmatics do…that was determined by blood levels of the drug after I took it.  I avoided the headaches by giving myself the shots at night just before I went to sleep.  Although the MTX worked as advertised (30% reduction in ‘roid dose) I was on such a large dose of prednisone that I was faced with side effects from the prednisone continuing and having to deal with the MTX side effects.  After much discussion, my doctors and I agreed to discontinue the MTX and see what happened.  I decided that I would not re-start the drug.  (there were some other things in the wings with respect to new therapies). GOOD THINGS TO REMEMBER:  All these asthma treatments work differently on different people.  What works for me might work even better for you or might be more than you want to try.  You, with the help of your doctors, are the only one who can decide what to try.  When you have really severe asthma that is not under control, you don’t have many options. I wish you the very best of luck.  The studies indicate that some folks are able to get off their prednisone completely with Methotrexate. Hope you’re one of the lucky ones! Pat Crockett, whose physicians assure her that the correct medical term for her condition is "god-awful asthma" . Path: news.asu.edu!asuvax!cs.utexas.edu!howland.reston.ans.net!pipex!uunet!German y.EU. net!netmbx.de!zib-berlin.de!news.th-darmstadt.de!fauern!rrze.uni-erlangen.d e!not -for-mail Newsgroups: alt.support.asthma Organization: Regionales Rechenzentrum Erlangen, Germany NNTP-Posting-Host: cd4680fs.rrze.uni-erlangen.de Lines: 18 X-Newsreader: NN version 6.5beta3.0 #2 (NOV) I am on MTX since since 1988 with no sideeffects . MTX was given to me during a stay at the Asthma Health Clinic in Davos (Switzerland). My weekly dosis is 15mg. This dosis is given as 5mg tablets every 12 hours spread over 36 hours. I have not experienced sideeffects like headache or any effects which are normally mentioned with MTX. My daily dosis of prednison has gone down extermly from 30mg to now 7,5mg. I am on no special diet, besides the normal bavarian diet, and I do sports on a regular basis. In Davos they told me that I should not get children while on MTX, but that I could if would take a break from MTX of 6 month. If you have any questions, do not hesitate to ask. Peter T. Klein – Hide quoted text — Show quoted text – > Hiya – > Just came back from the doctor’s office and it looks like I have to start > taking Methotrexate, until the study medicine I just finished taking comes out. >  It used to be used in chemotherapy for cancer patients and was found to have > great anti-inflammatory properties and works in some asthmatics. > I know the big side effect can be liver toxicity, and I will have to have liver > function tests once a month to keep track.  I would like to know if anyone else > has ever taken this medication, and if they had any other side effects. > Thanks in advance! > Life is uncertain – eat dessert first. > Nancy > 8=: )

Response:

> I know the big side effect can be liver toxicity, and I will have to have liver > function tests once a month to keep track.  I would like to know if anyone else > has ever taken this medication, and if they had any other side effects.

Hi I took methotrexate for four months and found that unfortunately it did nothing for my asthma. The major side effect I had was bowel trouble. Renae

Response:

Hiya – Just came back from the doctor’s office and it looks like I have to start taking Methotrexate, until the study medicine I just finished taking comes out.  It used to be used in chemotherapy for cancer patients and was found to have great anti-inflammatory properties and works in some asthmatics. I know the big side effect can be liver toxicity, and I will have to have liver function tests once a month to keep track.  I would like to know if anyone else has ever taken this medication, and if they had any other side effects. Thanks in advance! Life is uncertain – eat dessert first. Nancy 8=: )

Response:

> Hiya – > Just came back from the doctor’s office and it looks like I have to start > taking Methotrexate, until the study medicine I just finished taking comes out. ><Snip>

Nancy, I have discussed this drug with my doctor.  He is of the opinion that Methotrexate is not very effective at treating asthma.  We tried Cyclosporine and it works great.  I am on a much lower dose than what is recommended for transplant patients.  I am happy with the results and am starting to wean off of it. I am also trying gammaglobulin replacement therapy.  This with the Cyclosporine has changed my life dramatically. For side effects of the Methotrexate go to http://www.rxlist.com/cgi/generic/mtx_ad.htm#DI.  This is the adverse reaction section for Methotrexate.   — Good Luck. Lisa Hinsberg

Response:

> Just came back from the doctor’s office and it looks like I have to start > taking Methotrexate, until the study medicine I just finished taking comes out. >  It used to be used in chemotherapy for cancer patients and was found to have > great anti-inflammatory properties and works in some asthmatics. > I know the big side effect can be liver toxicity, and I will have to have liver > function tests once a month to keep track.  I would like to know if anyone else > has ever taken this medication, and if they had any other side effects. > Thanks in advance! > Life is uncertain – eat dessert first. > Nancy  8=: )

You can get more info from Medline using PubMed. For example: http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9893776&form=… Respir Med 1998 Aug;92(8):1059-65 Management of steroid-dependent asthma with methotrexate: a meta-analysis of randomized clinical trials. Aaron SD, Dales RE, Pham B Department of Medicine, Ottawa General Hospital,  University of Ottawa, Ontario, Canada. Our objective was to determine whether methotrexate is an effective steroid-sparing agent for patients with severe asthma. Published reports of controlled trials assessing the use of methotrexate in asthma were identified by a search of the MEDLINE, EMBASE, CINAHL, Biological Abstracts on CD, and Current Contents databases. Data from 12 studies, reporting on a total of 250 patients,  were pooled using a weighted average method, with weights  proportional to the inverse of the variance of the treatment  effect. Compared to placebo, the use of methotrexate was  associated with a pooled 6.0% improvement in FEV1  (95% CI, 1.0-11%) and an 18.2% reduction in oral steroid  use (95% CI, 11.7-24.7%). This corresponded to a 3.3 mg  day-1 greater reduction in oral steroid use for patients taking  methotrexate than for those taking placebo (95% CI, 2.1-4.4 mg day-1).  Gastrointestinal complications and transient increases in liver  enzymes were more common in patients randomized to methotrexate.  Three potentially life-threatening side-effects (two pneumonias  and one liver dysfunction) occurred in 159 patients randomized to  methotrexate vs. none in those patients on placebo. It was  concluded that methotrexate allowed a modest reduction in oral  corticosteroid compared to patients receiving placebo. The benefit  is relatively small, however, and should be balanced against the  potential for side-effects associated with the use of methotrexate. PMID: 9893776, UI: 99109774 There are a couple of paragraphs in the book The Asthma Sourcebook, 2nd Ed Nov 97, Francis Adams, MD Quoting: "Further studies have not been as positive and long term studies of adverse effects in asthmatic patients have not been completed. Since methotrexate may cause pneumonia and scarring of the lungs know as pulmonary fibrosis, its use in patients with underlying lung disease such as asthma may prove hazardous. An additional worrisome side effect is the potential for liver damage. Patients receiving methotrexate must have frequent blood tests for liver function, chest x-rays, and comprehensive pulmonary function tests looking for evidence of fibrosis. Unless further studies show a greater benefit to this drug’s use in bronchial asthma, it is likely to be used sparingly." You may want to ask your doctor if he has ever used methotrexate for asthma before and how it worked. You may also benefit from a 2nd opinion, preferably from an asthma expert–National Jewish in Denver has done research in this area 1-800-222-LUNG for advice. www.njc.org The final decision on whether to take this drug is your’s. Ellis

Response: