Evidence map›Paper›PMID 10796540›Full record

SynthesisThe Cochrane database of systematic reviews2000

Methotrexate as a steroid sparing agent for asthma in adults.

H Davies, L Olson, P Gibson

Open access · bronzeAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Cochrane database of systematic reviews, 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 3 pooled it
0.9field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 94 citations in OpenAlex.

  1. Methotrexate for primary biliary cirrhosis.The Cochrane database of systematic reviews · 2010
    Pooled it
  2. Pooled it
  3. Immunotherapy.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2005
    Guideline
  4. Article
  5. Review
  6. Airway Disease in Rheumatoid Arthritis.Annals of the American Thoracic Society · 2022
    Review
  7. Article
  8. Review
  9. Development of New Therapies for Severe Asthma.Allergy, asthma & immunology research · 2017
    Review
  10. Review
  11. Defining severe asthma - an approach to find new therapies.European clinical respiratory journal · 2014
    Review
  12. Article
  13. Severe refractory asthma: an update.European respiratory review : an official journal of the European Respiratory Society · 2013
    Review
  14. Review
  15. Article
  16. Optimal management of severe/refractory asthma.Clinical medicine insights. Circulatory, respiratory and pulmonary medicine · 2011
    Article
  17. Review
  18. Article
  19. New drugs targeting Th2 lymphocytes in asthma.Journal of occupational medicine and toxicology (London, England) · 2008
    Article
  20. Severe asthma.Clinical reviews in allergy & immunology · 2003
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

H DaviesRespiratory Medicine, John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, Newcastle, NSW, Australia, 2310. MDPGG@mail.newcastle.edu.au
L Olson
P Gibson
John Hunter Hospital · AURepatriation General Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSustained oral corticosteroid use can lead to complications, so there is interest in identifying agents that can reduce oral steroid use in people with asthma. Methotrexate has attracted attention as a possible steroid sparing agent in patients with chronic oral steroid dependent asthma.

objectivesThe objective of this review was to assess the effects of adding methotrexate to oral corticosteroids in adults with stable asthma who are dependent on oral corticosteroids. SEARCH STRATEGY: The Cochrane Airways Group trials register and reference lists of identified articles were searched. SELECTION CRITERIA: Randomised trials of the addition of methotrexate compared with placebo in adult steroid dependent asthmatics. Duration of therapy needed to be at least 12 weeks. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extraction was carried out by two reviewers independently. Study authors were contacted for missing information. MAIN

resultsTen trials involving a total of 185 people were included. Study design and quality, corticosteroid dosages and outcomes varied widely. There was a reduction in oral corticosteroid dose favouring methotrexate in parallel trials (weighted mean difference -4.1 mg per day, 95% confidence interval -6.8 to -1.3) and also in cross-over trials (weighted mean difference -2.9 mg per day, 95% confidence interval -5.9 to -0.2). There was no difference between methotrexate and placebo for forced expiratory volume in one minute (weighted mean difference 0.12 litre, 95% confidence interval -0.21 to 0.45). Hepatotoxicity was a common adverse effect with methotrexate compared to placebo (odds ratio 6.9, 95% confidence interval 3.1 to 15.5). REVIEWER'S

conclusionsMethotrexate may have a small steroid sparing effect in adults with asthma who are dependent on oral corticosteroids. However, the overall reduction in daily steroid use is probably not large enough to reduce steroid-induced adverse effects. This small potential to reduce the impact of steroid side-effects is probably insufficient to offset the adverse effects of methotrexate.

Indexed as

Administration, OralAdrenal Cortex HormonesAdultAsthmaDrug Therapy, CombinationHumansMethotrexateSubstance-Related DisordersAdrenal Cortex HormonesMethotrexate

Identifiers

PMID10796540
PMCPMC6483672
OpenAlexW1926554700

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.