Use of methotrexate for autoimmune hearing loss.
To assess the efficacy of low-dose methotrexate (MTX) given long-term for the treatment of autoimmune hearing loss, we performed a prospective open-label study of 11 patients with treatment-refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in 1 or both ears before enrollment despite traditional medical therapy. The MTX dose was 7.5 to 17.5 mg/wk. Hearing loss and vertigo were evaluated at baseline and at completion of the study. Hearing improvement was defined as an improvement in the pure tone threshold (PT) average of >10 dB or an increase in speech discrimination (SD) of >15%, whereas worsening was defined as a worsening of >10 dB in PT or a decrease of >15% in SD in at least 1 ear. The MTX was well tolerated. Among the 6 patients with Meniere's disease. 4 had improvement or resolution of vertigo, while 2 had no improvement. Disequilibrium improved in all 3 patients with Cogan's syndrome. According to the parameters defined above, hearing improved in 9 patients (82%), was unchanged in 1 patient (9%), and worsened in 1 patient (9%). Long-term low-dose MTX therapy may be a useful therapy for some patients who have hearing loss with a presumptively autoimmune-mediated component that is refractory to traditional therapies.
Matteson
E L
EL
Division of Rheumatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Tirzaman
O
O
Facer
G W
GW
Fabry
D A
DA
Kasperbauer
J
J
Beatty
C W
CW
McDonald
T J
TJ
D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006309:Hearing / Q000187:drug effects; D006311:Hearing Disorders / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy / Q000503:physiopathology; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D004856:Postural Balance / Q000187:drug effects; D011446:Prospective Studies; D014717:Vertigo / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D007166:Immunosuppressive Agents; D008727:Methotrexate