Variety of immunosuppressive drugs and antimalarics have been used in order to subdue granulomatous inflammation, in patients with sarcoidosis. The purpose of the study is to show the benefits of methotrexate in treating patients with chronic sarcoidosis.
In the Institute of Pulmonary Diseases in Belgrade (Serbia), methotrexate has been used in the treatment of sarcoidosis since 1997. During past 7 years out of 551 patients with biopsy positive pulmonary and extra pulmonary sarcoidosis, 134 (24,3%) received methotrexate or are still under this treatment. Out of the observed group 33/134 (24,6%) are male and 101/134(75,4%) are female patients. The mean age of the analyzed group is 49,76 years (SD 9,04). The onset of the lung disease was noticed according to the stage of the lung disease 0-IV (in 11,1%; 35,8%; 30,6%; 13,4%; 5,2%). 52% of patients have obstructive pattern of the lung function impairments. All patients have extra pulmonary sarcoidosis with different organs involvement. 32% of patients were receiving methotrexate as the single agent therapy while 78% were treated with corticosteroids at the beginning.
Six months after the initiation the chest X ray improvement was noticed in all patients followed by the lung function improvement for 10% or more (measuring FVC and FEV1). The symptoms and signs of the extra pulmonary disease were improved as well. After seven years of follow up, 32 pts have no treatment at all and not the signs of sarcoidosis activity. Patients who started the treatment with both methotrexate and steroids came to the morbostatic doses of prednisolone 5-10mg daily or alternatively, (52pts) or continued with methotrexate as the single agent. (20pts). In patients with the new onset of sarcoidosis (noticed three - six months after discontinuing the treatment) 32pts methotrexate was introduced again without the signs of any possible toxicity.
Among the alternatives methotrexate has shown the greatest promise in the treatment of sarcoidosis patients with chronic disease.
Although cytotoxic agent, methotrexate is recommended in the treatment of sarcoidosis patients..
V.V. Vucinic, None.