The original reports of using cytotoxic agents for sarcoidosis were case reports with few larger scale studies. We performed a retrospective analysis of sarcoidosis patients treated with methotrexate at our institution’s specialty clinic.
All biopsy-proven sarcoidosis patient charts were reviewed to identify patients who have been treated with methotrexate and had laboratory and pulmonary function test results available. Doses of prednisone and methotrexate, pulmonary function tests, and laboratory results were analyzed.
Seventy-two patients were identified for the study. Mean age of starting methotrexate therapy was 48 years old, with an average dose of 13.5 mg for 32 months. 46 patients were already taking prednisone at an average dose of 18.0 mg, and the mean reduction in prednisone dose was 12.7 mg after methotrexate therapy. 25 patients were weaned completely off prednisone over an average of 9.9 months, 13 patients had a decrease in dose, and 7 patients had an increase in the prednisone dose. In a subgroup of patients, the measured diffusion capacity corrected for alveolar volume (D/VA) remained normal in 26 patients, increased by 10% or more in 6 patients, and increased by less than 10% in 4 patients. The D/VA decreased by 10% or greater in 6 patients and decreased by less than 10% in 4 patients. There was no irreversible leukopenia with an average white blood cell count of 6200 thous/mcl over 32 months. Measured liver function tests including albumin, AST, ALT, and alkaline phosphatase remained stable over the course of treatment, even in patients with liver involvement of sarcoidosis. 9 patients were switched to subcutaneous methotrexate, 2 patients to etanercept, 3 patients to infliximab, and 1 to cytoxan.
38/46 (82.6%) of patients taking methotrexate were either weaned off prednisone or had a reduction in dose. 36/46 (78.3%) of D/VA remained normal or increased. There was no irreversible leukopenia, and LFT’s remained stable. Some patients required further alternative therapies.
Methotrexate is an acceptable steroid sparing agent for sarcoidosis with minimal toxicity.
A.G. Ko, None.