Methotrexate as a steroid sparing agent for asthma in adults

Cochrane Database Syst Rev. 2000;1998(2):CD000391. doi: 10.1002/14651858.CD000391.


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 strategy: The Cochrane Airways Group trials register and reference lists of identified articles were searched.

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).

Reviewer's 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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Administration, Oral
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects*
  • Adult
  • Asthma / drug therapy*
  • Drug Therapy, Combination
  • Humans
  • Methotrexate / therapeutic use*
  • Substance-Related Disorders / etiology
  • Substance-Related Disorders / prevention & control*


  • Adrenal Cortex Hormones
  • Methotrexate