PURPOSE: Two previous studies on pulmonary sarcoidosis [1, 2] have reported that six months treatment with antifungal medication alone or in combination with corticosteroids decreased the extent of granuloma formation in the lung to a larger extent than treatment with corticosteroid alone. This presentation reports data from a follow up of the group of patients that received antifungal medication only.
METHODS: The subjects (n =14) were recruited from newly diagnosed sarcoidosis patients at the clinic of respiratory diseases on a voluntary basis. They were given antifungal medication (Itraconazol 200 mg/day). Pulmonary x-ray was taken before and after treatment and determinations were made of serum angiotensin converting enzyme (sACE), chitotriosidase (CTO) and the ratio CD4/CD8 positive cells.
RESULTS: The duration of the treatment was 7 - 14 months (median 11.5). Four patients had to be given corticosteroids in addition to the antifungal treatment due to slow improvement of the disease parameters or worsening of symptoms. After termination of the antifungal treatment (n=10) there was an observation period of 1 - 35 months (median 3.5). At the end of the observation period all x-rays were normal. There were no cases of recurrence. sACE decreased from 0.41 when treatment was started to 0,31 μKat/L (p = 0.04) and CTO from 342 to 193 nmol/h/mL (p = 0.109). Among the patients where corticosteroid had to be added to the antifungal treatment, the CD4/CD8 ratio was slightly lower (2.6 vs 5.1, p = 0.161) and the number of patients with extrapulmonary manifestations was slightly higher (3 out of 4 as compared to 3 out of 10).
CONCLUSIONS: The results demonstrate that the beneficial effect of treatment with antifungal medication persists and that no recurrences occurred during the observation period. There were some differences in disease characteristics in the group where corticosteroids had to be added but further studies are needed to characterise those into clinically applicable criteria.
CLINICAL IMPLICATIONS: Antifungal medication could be considered as an alternative for treatment of sarcoidosis, particularly for chronic cases and those with recurrence.
DISCLOSURE: The following authors have nothing to disclose: Marjeta Tercelj, Barbara Salobir, Mirjana Zupancic, Ragnar Rylander
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