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This combination therapy involves the intratympanic administration of methotrexate, a folate antimetabolite, and adalimumab, a tumor necrosis factor (TNF) alpha inhibitor. Developed by researchers at the Shandong Second Provincial General Hospital, this regimen is specifically investigated for the treatment of refractory Meniere's disease. The rationale is to leverage the synergistic anti-inflammatory and immunomodulatory effects of both drugs locally within the inner ear to reduce endolymphatic hydrops and control vertigo symptoms in patients who have failed conventional treatments. Methotrexate acts by inhibiting dihydrofolate reductase, thereby interfering with DNA synthesis and providing anti-inflammatory effects, while adalimumab neutralizes TNF-alpha, a key pro-inflammatory cytokine implicated in the pathogenesis of inner ear disorders.
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