Methotrexate

[yaf_user681_34383]

I was just wondering if anyone takes methotrexate or cyclosporin. I may be starting one of them and would be interested to know peoples opinions as i know very little about them. Thankyou sadwheezer

[yaf_user681_25820]

hi

hi

I had methotrexate i didnt notice a diference but as its a once a week drug you have to take it for a while to see.

The reason im writting is that Do you want children in the near future?-whilst your on it if you become prgnant it cud give the baby birth defects. Also if you do want children you have to be off 2 yrs before you can try.

I was wondering if this was brought up in the discussion?

Not wanting to put you off but its worth thinking about

[yaf_user681_34383]

Thanks for your reply wheezer1 i was not aware of the risk to future childbearing. Does it apply to cyclosporin do you know?

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Methotrexate and ciclosporin are two drugs with immunosuppressive and anti-inflammatory action which are both used in asthma as ‘steroid-sparing agents’, to try to aid in reduction of steroid dose. The indication for starting one of these drugs would be a prolonged period on high dose steroids, with an inability to reduce the dose without the asthma flaring, and significant steroid side effects such as diabetes, high blood pressure, bone problems or eye problems.

There is reasonably well established evidence from a number of small trials that these drugs are effective in enabling some people to reduce their steroid dose. Azathioprine, another anti-inflammatory drug, is also often used in the same way in asthma; there is less trial based evidence for its use, but considerable anecdotal evidence from both consultants and patients that it can also be effective.

These are powerful drugs, albeit used at very small doses (methotrexate is used in much higher doses as a chemotherapy agent) and they do have significant side effects themselves. The worst side effect is often a suppressed immune system with increased susceptibility to infection - if you are someone who gets a lot of chest infections anyway, or who is frequently ventilated for your asthma, it may not be suitable for you.

Both drugs can cause fatigue, nausea and general malaise, and both also can cause kidney and liver dysfunction and bone marrow suppression with anaemia, low white cells and low platelets. Anyone taking either drug will have to have regular blood tests to check for these problems – probably initially weekly, moving to fortnightly and then monthly when things are stable. These problems are usually completely reversible provided they are picked up early and the drug is stopped. Ciclosporin can also cause hypertension, especially in susceptible individuals.

Methotrexate can also rarely cause alveolitis (inflammation of the alveoli, the air sacs of the lungs) which can progress to lung fibrosis. This is a rare complication, and again, if it is picked up early and the drug is stopped, the effects are usually largely reversible. Anyone on methotrexate for asthma would presumably be having regular lung function tests anyway, which should pick up this problem.

Methotrexate is definitely completely contraindicated in pregnancy – it opposes the action of folic acid, which is recommended to all pregnant women to reduce the risk of neural tube deformities such as spina bifida – taking methotrexate in pregnancy increases the risk of these defects. The BNF suggests avoiding conception for three months after stopping methotrexate – other authorities may recommend longer. This applies to both men and women – methotrexate can temporarily cause damage to the sperm as well.

Azathioprine is not known to be teratogenic, but its use has been associated with miscarriage, premature birth and low birth weight. The BNF comments that there is limited evidence or experience of the use of ciclosporin in pregnancy, but that it does not appear to be any more harmful than azathioprine.

I think most consultants would be reluctant to use any of these drugs in someone who intended to become pregnant. If you have severe asthma, pregnancy should be planned very carefully in any case; it may be worth asking for a referral to an obstetrician who specialises in the management of high-risk pregnancies

Personally, I have taken methotrexate twice - once in 1999, for about 10 months, and more recently in May - September 2006. The first time I took it, I was not aware of any particular side effects, and it was effective in allowing me to reduce my steroid dose. However, after some time, my liver function tests became slightly elevated (again without any symptoms) and I had to stop it. I tried it again in 2006, as I was experiencing significant side effects from prednisolone, including impaired glucose tolerance and hypertension. This time, I experienced mild nausea and loss of appetite for the first couple of days after taking it (it is taken weekly), but no other significant side effects. However, I was ventilated twice during this period and had ventilator-associated pneumonia and sepsis on both occasions, something that had never happened on previous occasions. This may have been coincidence, but my consultant felt that the risk was too great, and we stopped the methotrexate. I was going to try azathioprine (I can't have ciclosporin since my blood pressure is already high) but after having severe sepsis with multiple different organisms when I was ventilated in Feb - March last year (when I was not on immunosuppression, except pred), and similar, although thankfully less severe, problems during my most recent ventilation, everyone seems to think that further immunosupression is not in my best interests... I have to say I agree!

This is just my personal experience, and there may have been other factors involved with the infections that I got when I was on methotrexate. Apart from the two occasions when I was ventilated (which is a risk factor for pneumonia in itself), I didn't find that I got any more infections when I was on methotrexate than when off it. I know people who have had excellent responses to these drugs, and others who have not been able to tolerate them at all. One thing to take comfort from is the fact that everyone who is on these drugs is very closely monitored, so any problems will be picked up extremely quickly.

Hope this helps a bit, any other specific questions, do ask and I'll do my best to answer

Take care

Em H

[yaf_user681_34383]

Thankyou both for your replies. Its just useful to know how patients find different treatments. I need to consider what the next step is but anythings better than spending most of my time in hospital. Do these drugs cut down hospital admissions? Take care

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My son has been on Ciclosporin, Aziathropine and now just started Methrexate. The ciclosporin had very minimal effect on reducing steroids, didnt stop hospital admissions but the only side effect was hairy arms. Unfortunatly Sean had a seizure after 7 mths on xmas day, his con wasnt sure if it was ciclosporin or slo phyllin so stopped both. After a couple of mths we tried Aziathropine which was useless and discontinued in Jan. He is due to have third dose of methotrextae tommorow so its to early to tell if there is any benefit. There has been no obvious side effects yet but developed hacking cough after second dose which could just be coincidence. He has to stay on high dose I.M steroids for 3 mths while dose is gradually increased and then for 3 mths at maxium dose. The steroids should then be able to be weaned lower so sorry cant comment if its succesful or not till about sept time ! Not very helpful I know but I'll update you if anything changes re side effects etc.

J