Single, high-dose intramuscular triamcinolone acetonide versus weekly oral methotrexate in life-threatening asthma: a double-blind study.

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 ...