Low-dose methotrexate for advanced pulmonary disease in patients with cystic fibrosis

Respir Med. 2003 May;97(5):498-500. doi: 10.1053/rmed.2002.1471.


Inflammation is a hallmark in the pathogenesis of pulmonary destruction in cystic fibrosis (CF). There is no proven effective systemic anti-inflammatory treatment for CF patients with advanced pulmonary disease. Methotrexate (MTX) is known as an effective anti-inflammatory treatment in asthma and in juvenile rheumatoid arthritis. The question was: Is an improvement in pulmonary function achievable with low-dose MTX in patients with cystic fibrosis and advanced pulmonary disease.?

Methods: We treated five CF patients with advanced pulmonary disease, who deteriorated in spite of intensive conventional therapy on an individual basis with low-dose MTX. FEV1% and immunoglobulin G (IgG) serum levels were followed from the year before to the year after starting with MTX.

Results: In the year before starting with MTX, FEV1% decreased (median: 10% FEV1; range 9-15% FEV1; P<0.005) after starting with MTX, FEV1% increased (median: 9% FEV1; range: 2-15% FEV1; P<0.05). IgG changed (median: -2 g/l; range: 0.2 to -7.3 g/l) in the first year with MTX.

Conclusion: These preliminary data suggest a beneficial effect of MTX even in advanced pulmonary disease in CF patients and supports the need for a controlled prospective study.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Child
  • Cystic Fibrosis / drug therapy*
  • Cystic Fibrosis / immunology
  • Cystic Fibrosis / physiopathology
  • Female
  • Forced Expiratory Volume / drug effects
  • Humans
  • Immunoglobulin G / blood
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Methotrexate / therapeutic use*
  • Pneumonia / drug therapy*
  • Pneumonia / immunology
  • Pneumonia / physiopathology
  • Retrospective Studies


  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Methotrexate