Methotrexate as a steroid sparing agent for asthma in adults.

Abstract:

BACKGROUND:Sustained 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. OBJECTIVES:The 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 RESULTS:Ten 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 CONCLUSIONS:Methotrexate 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.

authors

Davies H,Olson L,Gibson P

doi

10.1002/14651858.CD000391

keywords:

subject

Has Abstract

pub_date

2000-01-01 00:00:00

pages

CD000391

issue

2

issn

1469-493X

pii

CD000391

pub_type

杂志文章,评审
  • Treatment of urinary incontinence after stroke in adults.

    abstract:BACKGROUND:Urinary incontinence can affect 40-60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and 15% remaining incontinent at one year. OBJECTIVES:To determine the optimal methods for treatment of urinary incontinence after stroke in adults. SEARCH STRATEGY:We ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004462.pub3

    authors: Thomas LH,Cross S,Barrett J,French B,Leathley M,Sutton CJ,Watkins C

    更新日期:2008-01-23 00:00:00

  • An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons.

    abstract:BACKGROUND:Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this pop...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD013458.pub2

    authors: Uphoff E,Robertson L,Cabieses B,Villalón FJ,Purgato M,Churchill R,Barbui C

    更新日期:2020-09-04 00:00:00

  • Interventions for preventing falls in people after stroke.

    abstract:BACKGROUND:Falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. OBJECTIVES:To evaluate the effectiveness of in...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008728.pub2

    authors: Verheyden GS,Weerdesteyn V,Pickering RM,Kunkel D,Lennon S,Geurts AC,Ashburn A

    更新日期:2013-05-31 00:00:00

  • Inositol for respiratory distress syndrome in preterm infants.

    abstract:BACKGROUND:Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life. OBJECTIVES:To assess the effectiveness/safety of supplementary inositol in preterm inf...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000366

    authors: Howlett A,Ohlsson A

    更新日期:2000-01-01 00:00:00

  • Fluid and pharmacological agents for adhesion prevention after gynaecological surgery.

    abstract:BACKGROUND:Adhesions are fibrin bands that are a common consequence of gynaecological surgery. They are caused by various conditions including pelvic inflammatory disease and endometriosis. Adhesions are associated with considerable co-morbidity, including pelvic pain, subfertility and small bowel obstruction. Patients...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001298.pub4

    authors: Ahmad G,Mackie FL,Iles DA,O'Flynn H,Dias S,Metwally M,Watson A

    更新日期:2014-07-09 00:00:00

  • WITHDRAWN: Follicle-stimulating hormone and human menopausal gonadotropin for ovarian stimulation in assisted reproduction cycles.

    abstract:BACKGROUND:Both human menopausal gonadotropin (hMG) and human follicle stimulating hormone (hFSH) have been used successfully for ovarian stimulation, but the relative importance of FSH and luteinizing hormone (LH) in follicular growth and maturation has been the subject of much debate. OBJECTIVES:To conduct a systema...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000061

    authors: Daya S

    更新日期:1996-04-22 00:00:00

  • Assessment and support during early labour for improving birth outcomes.

    abstract:BACKGROUND:The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD011516.pub2

    authors: Kobayashi S,Hanada N,Matsuzaki M,Takehara K,Ota E,Sasaki H,Nagata C,Mori R

    更新日期:2017-04-20 00:00:00

  • Homocysteine-lowering interventions for preventing cardiovascular events.

    abstract:BACKGROUND:Cardiovascular disease, which includes coronary artery disease, stroke and congestive heart failure, is a leading cause of death worldwide. Homocysteine is an amino acid with biological functions in methionine metabolism. A postulated risk factor is an elevated circulating total homocysteine level, which is ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006612.pub4

    authors: Martí-Carvajal AJ,Solà I,Lathyris D

    更新日期:2015-01-15 00:00:00

  • Hyperbaric oxygen therapy for Bell's palsy.

    abstract:BACKGROUND:Bell's palsy is an idiopathic, acute unilateral facial weakness that evolves rapidly and is maximal within two days. Moderate ear discomfort, sensitivity to sound and reduced tearing may occur. OBJECTIVES:To assess the effects of hyperbaric oxygen therapy on recovery of facial function in adults with modera...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007288.pub2

    authors: Holland NJ,Bernstein JM,Hamilton JW

    更新日期:2012-02-15 00:00:00

  • Dietary supplements for established atopic eczema.

    abstract:BACKGROUND:Many people with atopic eczema are reluctant to use the most commonly recommended treatments because they fear the long-term health effects. As a result, many turn to dietary supplements as a possible treatment approach, often with the belief that some essential ingredient is 'missing' in their diet. Various...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005205.pub3

    authors: Bath-Hextall FJ,Jenkinson C,Humphreys R,Williams HC

    更新日期:2012-02-15 00:00:00

  • Oral aspirin for treating venous leg ulcers.

    abstract:BACKGROUND:Venous leg ulcers (VLUs) or varicose ulcers are the final stage of chronic venous insufficiency (CVI), and are the most common type of leg ulcer. The development of VLUs on ankles and lower legs can occur spontaneously or after minor trauma. The ulcers are often painful and exudative, healing is often protra...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009432.pub2

    authors: de Oliveira Carvalho PE,Magolbo NG,De Aquino RF,Weller CD

    更新日期:2016-02-18 00:00:00

  • Interventions for helping to turn term breech babies to head first presentation when using external cephalic version.

    abstract:BACKGROUND:Breech presentation is associated with increased complications. Turning a breech baby to head first presentation using external cephalic version (ECV) attempts to reduce the chances of breech presentation at birth so as to avoid the adverse effects of breech vaginal birth or caesarean section. Interventions ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000184.pub4

    authors: Cluver C,Gyte GM,Sinclair M,Dowswell T,Hofmeyr GJ

    更新日期:2015-02-09 00:00:00

  • Prosthetic rehabilitation for older dysvascular people following a unilateral transfemoral amputation.

    abstract:BACKGROUND:Dysvascularity accounts for 75% of all lower limb amputations in the UK. Around 37% of these are at transfemoral level (mid-thigh), with the majority of people being over the age of 60 and having existing co-morbidities. A significant number of these amputees will be prescribed a lower limb prosthesis for wa...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD005260.pub2

    authors: Cumming JC,Barr S,Howe TE

    更新日期:2006-10-18 00:00:00

  • Risk scoring for the primary prevention of cardiovascular disease.

    abstract:BACKGROUND:The current paradigm for cardiovascular disease (CVD) emphasises absolute risk assessment to guide treatment decisions in primary prevention. Although the derivation and validation of multivariable risk assessment tools, or CVD risk scores, have attracted considerable attention, their effect on clinical outc...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006887.pub4

    authors: Karmali KN,Persell SD,Perel P,Lloyd-Jones DM,Berendsen MA,Huffman MD

    更新日期:2017-03-14 00:00:00

  • Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus.

    abstract:BACKGROUND:Many hormonal contraceptives have been associated with changes in carbohydrate metabolism. Alterations may include decreased glucose tolerance and increased insulin resistance, which are risk factors for Type 2 diabetes mellitus and cardiovascular disease. These issues have been raised primarily with contrac...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006133.pub5

    authors: Lopez LM,Grimes DA,Schulz KF

    更新日期:2014-04-30 00:00:00

  • Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease.

    abstract:BACKGROUND:Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and language therapy (SLT) aims to improve the intelligibility of spe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002812.pub2

    authors: Herd CP,Tomlinson CL,Deane KH,Brady MC,Smith CH,Sackley CM,Clarke CE

    更新日期:2012-08-15 00:00:00

  • Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolaemia.

    abstract:BACKGROUND:A cholesterol-lowering diet and several other dietary interventions have been suggested as a management approach either independently or as an adjuvant to drug therapy in children and adults with familial hypercholesterolaemia (FH). However, a consensus has yet to be reached on the most appropriate dietary t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001918.pub3

    authors: Malhotra A,Shafiq N,Arora A,Singh M,Kumar R,Malhotra S

    更新日期:2014-06-10 00:00:00

  • Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion.

    abstract:BACKGROUND:Concerns regarding the safety of transfused blood have led to the development of a range of interventions to minimise blood loss during major surgery. Anti-fibrinolytic drugs are widely used, particularly in cardiac surgery and previous reviews have found them to be effective in reducing blood loss and the n...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001886.pub2

    authors: Henry DA,Carless PA,Moxey AJ,O'Connell D,Stokes BJ,McClelland B,Laupacis A,Fergusson D

    更新日期:2007-10-17 00:00:00

  • Virtual reality for stroke rehabilitation.

    abstract:BACKGROUND:Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. OBJECTIVES:To evaluate the effec...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008349.pub2

    authors: Laver KE,George S,Thomas S,Deutsch JE,Crotty M

    更新日期:2011-09-07 00:00:00

  • Imaging modalities for characterising focal pancreatic lesions.

    abstract:BACKGROUND:Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD010213.pub2

    authors: Best LM,Rawji V,Pereira SP,Davidson BR,Gurusamy KS

    更新日期:2017-04-17 00:00:00

  • Pain management for sickle cell disease.

    abstract:BACKGROUND:Sickle cell disease is an inherited genetic disorder characterized by an abnormality of haemoglobin that predisposes to polymerization and consequent deformation ("sickling"). Sickle cell disease can cause episodes of acute severe pain. Chronic pain may also occur. Currently, pain is inadequately managed. O...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003350.pub2

    authors: Dunlop RJ,Bennett KC

    更新日期:2006-04-19 00:00:00

  • Calcium channel blockers for people with chronic kidney disease requiring dialysis.

    abstract:BACKGROUND:Calcium channel blockers (CCBs) are used to manage hypertension which is highly prevalent among people with chronic kidney disease (CKD). The treatment for hypertension is particularly challenging in people undergoing dialysis. OBJECTIVES:To assess the benefits and harms of calcium channel blockers in patie...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD011064.pub2

    authors: Mugendi GA,Mutua FM,Natale P,Esterhuizen TM,Strippoli GF

    更新日期:2020-10-01 00:00:00

  • Inhaled analgesia for pain management in labour.

    abstract:BACKGROUND:Many women would like to have a choice in pain relief during labour and also would like to avoid invasive methods of pain management in labour. Inhaled analgesia during labour involves the self-administered inhalation of sub-anaesthetic concentrations of agents while the mother remains awake and her protecti...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009351.pub2

    authors: Klomp T,van Poppel M,Jones L,Lazet J,Di Nisio M,Lagro-Janssen AL

    更新日期:2012-09-12 00:00:00

  • Pharmacological interventions for clozapine-induced hypersalivation.

    abstract:BACKGROUND:Clozapine is widely used for people with schizophrenia. Although agranulocytosis, weight gain, and cardiac problems are serious problems associated with its use, hypersalivation, sometimes of a gross and socially unacceptable quantity, is also common (30-80%). OBJECTIVES:To determine the clinical effects of...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD005579.pub2

    authors: Syed R,Au K,Cahill C,Duggan L,He Y,Udu V,Xia J

    更新日期:2008-07-16 00:00:00

  • Antidepressant drugs for narcolepsy.

    abstract:BACKGROUND:Narcolepsy is a disorder of the central nervous system, the main symptoms of which are excessive daytime sleepiness (EDS) and cataplexy (an abrupt and reversible decrease in or loss of muscle tone, affecting the limbs or trunk or both, elicited by emotional stimuli). Narcolepsy has an adverse impact on peopl...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003724.pub3

    authors: Vignatelli L,D'Alessandro R,Candelise L

    更新日期:2008-01-23 00:00:00

  • Angiogenesis-inhibitors for metastatic thyroid cancer.

    abstract:BACKGROUND:Systemic cytostatic therapies for advanced, metastatic thyroid carcinomas have been poorly effective. Tumor growth and metastasis depend on blood supply and blood vessel formation (angiogenesis). Therefore, inhibition of angiogenesis may represent a promising target for cancer therapy. OBJECTIVES:To evaluat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007958.pub2

    authors: Tan A,Xia N,Gao F,Mo Z,Cao Y

    更新日期:2010-03-17 00:00:00

  • Music during caesarean section under regional anaesthesia for improving maternal and infant outcomes.

    abstract:BACKGROUND:Evidence on the benefits of music during caesarean section under regional anaesthesia to improve clinical and psychological outcomes for mothers and infants has not been established. OBJECTIVES:To evaluate the effectiveness of music during caesarean section under regional anaesthesia for improving clinical ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006914.pub2

    authors: Laopaiboon M,Lumbiganon P,Martis R,Vatanasapt P,Somjaivong B

    更新日期:2009-04-15 00:00:00

  • Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

    abstract:BACKGROUND:Randomized controlled trials have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in unselected patients remains a controversial issue. OBJECTIVES:The objective of this review was t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004476.pub3

    authors: Blessberger H,Kammler J,Domanovits H,Schlager O,Wildner B,Azar D,Schillinger M,Wiesbauer F,Steinwender C

    更新日期:2018-03-13 00:00:00

  • Laparoscopic "drilling" by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome.

    abstract:BACKGROUND:Problems in inducing ovulation in women with polycystic ovary syndrome (PCOS) and anovulation (failure to ovulate) are well recognised. Surgical ovarian wedge resection was the first established treatment for anovulatory PCOS patients but was largely abandoned because of the risk of post-surgical adhesion fo...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001122

    authors: Farquhar C,Vandekerckhove P,Lilford R

    更新日期:2001-01-01 00:00:00

  • Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment.

    abstract:BACKGROUND:Dental implants require sufficient bone to be adequately stabilised. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. OBJECTIVES:General objectives: To test the null hypothesis of no diff...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003607.pub2

    authors: Esposito M,Grusovin MG,Worthington HV,Coulthard P

    更新日期:2006-01-25 00:00:00