L H Salley1, M Grimm, A Sismanis, R F Spencer, C M Wise. 1. Department of Otolaryngology, Head and Neck Surgery, Medical College of Virginia at Virginia Commonwealth University, Richmond 23298, USA.
Abstract
OBJECTIVE: To describe our experience with low dose weekly methotrexate (MTX) in the management of immune mediated cochleovestibular disorder (IMCVD). METHODS: Between 1991 and 1999, we treated 53 patients with IMCVD with MTX. Patients were selected on the basis of progressive vestibular symptoms that had responded to corticosteroids and in most cases, relapsed. MTX was initiated at a dose of 7.5 mg weekly and increased to doses up to 25 mg weekly as needed. Response was assessed by audiologic studies and history of change in tinnitus and vertigo. MTX was discontinued after 4-6 mo in patients showing no improvement, and after 12-18 mo in patients with improved and stable symptoms. RESULTS: Three patients were still in early therapy and had not improved. Of the 50 remaining patients, significant improvement was seen in vertigo in 27/39 (69%) patients, hearing loss in 25/47 (53%), and tinnitus in 11/42 (26%). Overall improvement in symptoms was seen in 35/50 (70%) patients. Four patients stopped MTX due to toxicity, and 11 due to lack of response. In 28 patients, MTX was stopped after 12-18 mo when symptoms had stabilized, and restarted in 5 of these after relapse. Seven patients remain on therapy with improved and stable symptoms after 17.3 mo. CONCLUSION: In this open label experience, a majority of patients with IMCVD improved with weekly low dose MTX therapy with minimal toxicity.
OBJECTIVE: To describe our experience with low dose weekly methotrexate (MTX) in the management of immune mediated cochleovestibular disorder (IMCVD). METHODS: Between 1991 and 1999, we treated 53 patients with IMCVD with MTX. Patients were selected on the basis of progressive vestibular symptoms that had responded to corticosteroids and in most cases, relapsed. MTX was initiated at a dose of 7.5 mg weekly and increased to doses up to 25 mg weekly as needed. Response was assessed by audiologic studies and history of change in tinnitus and vertigo. MTX was discontinued after 4-6 mo in patients showing no improvement, and after 12-18 mo in patients with improved and stable symptoms. RESULTS: Three patients were still in early therapy and had not improved. Of the 50 remaining patients, significant improvement was seen in vertigo in 27/39 (69%) patients, hearing loss in 25/47 (53%), and tinnitus in 11/42 (26%). Overall improvement in symptoms was seen in 35/50 (70%) patients. Four patients stopped MTX due to toxicity, and 11 due to lack of response. In 28 patients, MTX was stopped after 12-18 mo when symptoms had stabilized, and restarted in 5 of these after relapse. Seven patients remain on therapy with improved and stable symptoms after 17.3 mo. CONCLUSION: In this open label experience, a majority of patients with IMCVD improved with weekly low dose MTX therapy with minimal toxicity.