Am. J. Respir. Crit. Care Med., Vol 152, No. 5, 11 1995, 1461-1466.
Single, high-dose intramuscular triamcinolone acetonide versus weekly oral methotrexate in life-threatening asthma: a double-blind study
RG Ogirala, TM Sturm, TK Aldrich, FF Meller, EB Pacia, AM Keane and RI Finkel
Department of Medicine, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York 10467-2490, USA.
Effective and less toxic treatments are needed for patients with severe,
steroid-dependent asthma. Both low-dose oral methotrexate and high-dose
intramuscular triamcinolone have been recommended for these patients. We
compared the effects of these two medications on pulmonary function, peak
flow rates, airway reactivity, oral steroid use, emergency room (ER)
visits, and hospitalizations in patients with steroid-dependent,
life-threatening asthma. In a randomized, placebo- controlled, double-blind
study, we investigated 19 such patients. Six of the patients (Group I)
received a single dose of 360 mg triamcinolone intramuscularly with placebo
methotrexate; seven patients (Group II) received placebo triamcinolone
followed by low-dose oral methotrexate (a first dose of 7.5 mg followed by
15 mg weekly); and six patients (Group III) received placebo triamcinolone
with placebo methotrexate. All patients used the same high-dose inhaled
steroids. The patients took tapering courses of oral steroids when needed,
but attempted to reduce their oral steroid use whenever possible.
Methacholine challenge testing was performed every 6 wk, pulmonary function
tests every 4 wk, and home peak-flow measurements twice daily. Oral steroid
use, ER visits, and hospitalizations were also monitored. The patients in
the triamcinolone treatment group showed a significant and sustained
increase in home peak-flow rates, and their FEV1 persistently improved by a
mean of 40% (p < 0.05), whereas the FEV1 of the patients in the
methotrexate treatment and placebo groups remained near baseline. The PC20
in the triamcinolone group increased progressively (p > 0.05), and the
improvements in total mean reactivity were greater in this group than in
either of the other two groups (p < 0.05).(ABSTRACT TRUNCATED AT 250
WORDS)
