Methotrexate/Cyclosporine

Hi

I saw my consultant a few weeks ago in clinic and he thinks that Cyclosporine or Methotrexate (Cyclosporine was the one actually suggested in clinic) might be the next thing to try, at the time I expressed that I did not feel comfortable with the idea of immunosuppresants and he has since wrote to my GP stating that he feels there isn't much else to try. I explained to my GP why I feel uncomfortable with the idea of these drugs, I am just basically asking what are the risks and side effects of immunosuppresants and if you feel they are worth it for the improvement in asthma? I have come away today in particular feeling quite fed up but if the risk of immunosuppresants is worth it I would consider them. Oh and I have a high IgE (over 5000) if that helps.

Any replies appreciated.

Simi x

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Hi Simi,

Sorry to hear things are tough for you. You are essentially describing the use of methotrexate or cycosporin as a steroid sparing agent i.e something prescribed in an attempt to improve your asthma and hopefully allow you to reduce your oral steroids.

Methotrexate works by inhibiting the action of folate acid and therefore prevents DNA replication and cell growth. It is commonly used in cancer treatment and the treatment of autoimmune diseases such as rheumatoid arthritis. It comes as a tablet, usually taken weekly. Possible side effects of methrotrexate include problems with anaemia and bone marrow suppression, lung fibrosis and inflammation of the liver. Patients have blood tests checked every 6 weeks or so (longer if they have been stable on it for a long time) and may have their pulmonary function tests monitored (I imagine yours are being done already.) It is important to note that methotrexate is very harmful during pregnancy.

Cyclosporin/ciclosporin is an immunosuppressant used most commonly in people who have received transplants. Its mechanism of action is fairly complex but it essentially acts to reduce the function of white blood cells. It is given as a soft jelly like capsule taken daily. Ciclosporin tends to react with a fairly wide range of other drugs and grapefruit juice so it’s always worth mentioning. Ciclosporin is also associated with some side effects these include liver and kidney dysfunction and increased susceptibility to infections. There are quite a few other side effects but in the interests of not scaring you half to death I’ll let you look them up if you want!

In terms of wherever you feel it is personally worth trying one of these agents the best person to discuss it with is your Consultant- it’s a very individual decision. It is worth remembering that prednisolone in itself is also an immunosuppressant and has considerable long term side effects of its own as many here will testify!

Just prior to me doing the difficult asthma protocol my Consultant very seriously considered Methotrexate for me. A CT scan then showed quite bad bronchiectasis and an immune deficiency so that sort of ruled it out. I’m not that keen on new meds- my consultant told me I was the first person to get funding approved for Xolair and then decide I didn’t want it! I did have a very serious think about methotrexate and had decided to give it a go- then I was told I couldn’t have it anyway.

Hope my ramblings help, I hope you come to a decision with your Consultant and that you are happy with it whatever you decide, if you want more info try BNF or wikipedia.

Feel free to PM,

SX

PS. Do you volunteer on KA holidays?? If so I think I know who you are

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methotrexate

I was given methotrexate for about 9 months together with folic acid. This was tried with the aim to reduced the dose of oral steriods. I had no side effects but no real beneficial effects. REgular blood test to monitor liver function etc. Could not have childern whlist on the methotrexate and for another 6 months.

John

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Hi

Thank you both for your replies and the PMs I have received from others.

Thank you for your detailed reply ST, the clarification of what each of these drugs does and effects etc has been helpful. Your 'ramblings' definitely did help! I will give this decision some proper thought, as I do realise it could help a lot but have been a bit hesitant due to side effects that can result from these treatments.

I am a member of the Asthma UK Youth Forum but not a KA holiday volunteer at the moment but it’s something I hope to do at some point.

Hope you are both doing well at the moment.

Thanks again Simi x