Methotrexate: can it be a choice for nasal polyposis in aspirin exacerbated respiratory disease?

J Asthma. 2009 Dec;46(10):1037-41. doi: 10.3109/02770900903242704.


Nasal polyposis (NP) is considered a subgroup of chronic rhinosinusitis and is commonly associated with asthma, bronchiectasis, and cystic fibrosis. A certain subgroup of nasal polyposis is known as Aspirin Exacerbated Respiratory Disease (AERD), previously called Samter's Triad or aspirin triad, comprising polyposis, asthma, and aspirin hypersensitivity and makes up almost 10% of cases of NP. Therapy of NP involves a combination of medical and surgical treatments. However, recurrences are common, particularly in patients with asthma and aspirin hypersensitivity. Both topical and systemic corticosteroids form the mainstay of conservative therapy for NP as well as a primary treatment and prevention for recurrences. They have been shown to improve nasal breathing, rhinitis symptoms, and reduce the size of NP, along with the rate of recurrence. There is great concern about the adverse effects of systemic steroids, especially when long-term usage is necessary to maintain improvement. So far, no knowledge exists about the effects of methotrexate (MTX) on NP of the patients with asthma. We report two patients whose NP dramatically reduced in size after a course of MTX therapy administered as an additional treatment for their steroid- dependent asthma.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Aspirin / immunology*
  • Asthma / complications
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Drug Hypersensitivity / complications*
  • Endoscopy
  • Female
  • Forced Expiratory Volume / drug effects
  • Forced Expiratory Volume / physiology
  • Humans
  • Methotrexate / pharmacology
  • Methotrexate / therapeutic use*
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Nasal Cavity / drug effects
  • Nasal Cavity / pathology
  • Nasal Polyps / complications
  • Nasal Polyps / diagnostic imaging
  • Nasal Polyps / drug therapy*
  • Nasal Polyps / pathology
  • Paranasal Sinuses / diagnostic imaging
  • Paranasal Sinuses / drug effects
  • Tomography, X-Ray Computed


  • Adrenal Cortex Hormones
  • Aspirin
  • Methylprednisolone
  • Methotrexate