cyclosporin

has anyone had experience of cyclosporin or methatraxate as a steriod sparing agent? Would be grateful for any feedback

Julie xx

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Hi Julie,

I was prescribed Methotrexate (once a week tablet) for severe atopic eczema around eight years ago now when having major problems with my eczema. At the time my asthma was just starting to become uncontrolled, but was not as bad as my eczema. (Got the severe atopic asthma and eczema condition)

The side effects were much worse than any other asthma ‘relief’ drug I’ve ever taken, including pred, theophylline, high doses of LABA’s, low dose long term antibi’s etc. Side effects included dramatic weight loss, 1.5 stone in eight weeks, exceptional sickness, -much worse than the theo – and chronic tiredness.

But I have to say the methotrexate did have a miraculous effect upon both skin and lungs. So it could be argued that it worked. However I wasn’t then, and am not now, convinced of the long term safety of this drug re the treatment of asthma. But this is my personal opinion.

The last three times I have been to the chest clinic these two drugs have always been wheeled out as an alternative to pred because, for various reasons ( some medical) I want to try and manage without the pred. But, unfortunately ATM have returned to because of severe breathlessness and pathetic pf. However I am still very wary of both the cyclosporin and the methotrexate

BTW if you go back to the old AUK forum, web ref :

asthmabulletin.org.uk/discu...

and type in methotrexate on the search option you will find lots more discussion and info. I remember posting one about this subject, and have copied and pasted this web ref from an old post in order to try and present a more balanced perspective:

gpnotebook.co.uk/simplepage...

‘The inflammatory process underlying bronchial asthma is well established and has prompted clinical interest in nonsteroidal anti-inflammatory forms of treatment. Although unproven, it has been suggested that effective treatment of allergic inflammation may prevent long term consequences of asthma and avert deterioration in pulmonary function. Methotrexate has potent anti-inflammatory actions, even at low doses, and was judged to be a suitable candidate drug for asthma treatment if it could demonstrate an acceptable tolerability profile. Low dose methotrexate has been investigated in both noncomparative studies and in placebo-controlled studies of severe asthma. In general, such studies have suggested that methotrexate may have steroid-sparing benefits coupled to generally mild adverse events; although adverse effects were not of a serious nature they were observed in up to one-third of patients. Rare but potentially life-threatening adverse effects involving the pulmonary, hepatic and haematological systems remain of particular concern. Methotrexate should therefore be considered as an adjunct to high dose inhaled corticosteroids in patients who require more than 10mg of prednisolone daily, and who experience severe and unacceptable steroid-related adverse effects. Treatment should only be initiated by physicians with experience in the use of the drug, and the relevant safety parameters should be closely monitored.’

The best thing you can do Julie is to find out as much info about these drugs as possible (try googling for a start as well as checking the old AUK forum) and then go and have a talk with your chest con.

Good luck and take care,

Mia

xxx

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Thank you so much for such a detailed responseMia. The chest cons at rbh suggest this as next step for my son sean who is 10. They think he has built up some steriod resistance and also he needing such huge doses. This current admission he needed up to 40mg dexmethsone eqiv to 250mg a day pred which is crazy. I guess its just weighing up the effects of high dose steriod compered to sparing agents. He has inflated like a balloon this admission, i have never seen him bloat like this in such short space time. He had final test today before he can start drug but not sure when he will start, maybe next week. I just pray I havent made wrong decision.

Julie xx

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Methotrexate

Hi Julie,

I took methotrexate for about 6 months back in 1998, and have just been started on it again 3 weeks ago as I can't get my steriods down and I'm running into side effects like high sugars and of course weight gain.

I was given the choice of methotrexate or ciclosporin, and decided to go with methotrexate because the side effect profile seemed better, in particular I was worried about the ciclosporin causing high blood pressure as mine is already borderline high.

I can't recall noticing any side effects when I took it before, although I can't remember why it was stopped. This time around I've noticed some very mild nausea and loss of appetite, and I've lost a couple of pounds so far, which is no bad thing for me! They're monitoring my bloods every fortnight to check for signs of liver damage or bone marrow suppression.

The list of side effects for these drugs do sound scary, and it took me a while to come to the decision to go back on the metho, but I feel that for me the steroid side effects are worse in the long term. They monitor you pretty closely when you're on these things and I would imagine with a child they'll monitor even more closely.

I do know people who've been tried on other anti-inflammatory drugs for asthma, in particular azathioprine (usually used in inflammatory bowel disease) - there's less evidence for these but I've heard good reports.

Hope this helps a bit; I'll let you know if the metho is successful in helping me get my pred dose down!

I wish you all good wishes; it's bad enough having bad asthma personally, I can't even begin to imagine how much worse it would be to have to watch a child of mine go through it.

Take care

Emily H