Sarcoidosis is a granulomatous disorder commonly affecting the young adults and causes bilateral hilar adenopathy as the most common pulmonary manifestation. The conventional treatment of this disorder is corticosteroids which can have serious side effects like hypertension, diabetes, cataracts, etc. Since hydroxychloroquine(HCQS) has been used safely to treat cutaneous sarcoidosis, we evaluated HCQS as a safer alternative to glucocorticoids in patients with pulmonary sarcoidosis.
Eleven consecutive patients with Stage II or III of sarcoidosis were administered HCQS (600mg/day, 400mg/day and 200mg/day for 2 months each respectively. The patients were evaluated at 1,3, and 6, months of therapy with clinical examination, skiagrams chest, Mantoux test, lung function tests including tests for diffusion impairment, diffusion lung capacity for carbon monoxide (DLCO).
In all patients there was a marked relief in constitutional symptoms like fever and myalgias. Partial or complete resolution of hilar adenopathy and pulmonary infiltrates was also evident in all. Pulmonary function testing, done after 6 months of therapy, revealed improvement in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) in 8 patients and DLCO in 3.FVC (% predicted) and FEV1 (% predicted) changed from a pretreatment level of 77.3±15.6 and 71.8±16.7 to 80.75 ± 6.1 and 81.6 ±19.4 respectively at 6 months.In 3 patients FVC and FEV1 remained unchanged.Mantoux test remained <2mm in all. Two patients developed diarrhea which was self limiting. There were no other complications.
HCQS is a safe, effective and attractive alternative to coricosteroids in sarcoidsosis. However, this is a small pilot study and a larger study is needed before HCQS can be prescribed routinely in pulmonary sarcoidosis.
Hydroxycholoroquine is an effective alternative to corticosteroids in treatment of sarcoidosis and is free from any serious side effects.
R. Sharma, None.