Low-dose methotrexate for advanced pulmonary disease in patients with cystic fibrosis

Inflammation is a hallmark in the pathogenesis of pulmonary destruction in cystic fibrosis (CF). There is no proven effective systemic anti-inflammatory treatment for CIF patients with advanced pulmonary disease. Methotrexate (MTX) is known as an effective anti-inflammatory treatment in asthma and in juvenile rheumatoid arthritis. The question was: Is an improvement in pulmonary function achievable with low-dose MTX in patients with cystic fibrosis and advanced pulmonary disease.? Methods: We treated five CF patients with advanced pulmonary disease, who deteriorated in spite of intensive conventional therapy on an individual basis with low-dose MTX. FEVI% and immunoglobulin G (IgG) serum levels were followed from the year before to the year after starting with MTX. Results: In the year before starting with MTX, FEVI% decreased (median: 10% FEVI; range 9-15% FEVI; P<0.005) after starting with MTX, FEVI% increased (median: 9% FEVI; range: 2-15% FEVI; P<0.05). IgG changed (median: -2g/l; range: 0.2 to -73 g/l) in the first year with MTX. Conclusion: These preliminary data suggest a beneficial effect of MTX even in advanced pulmonary disease in CF patients and supports the need for a controlled prospective study. (C) 2002 Elsevier Science Ltd. All rights reserved.