PURPOSE: Many of the complications of sarcoidosis are caused by its steroid therapy. These include diabetes mellitus, osteoporosis and infection. Standard steroid sparing agents either have severe side effects (antimetabolites, thalidomide and TNFα binding agents) or are relatively ineffective (antimalarials). Pentoxifylline blocks secretion of TNFα and has shown activity against mild sarcoidosis while doxycycline inhibits matrix metalloproteases (remodelling enzymes) and is active against cutaneous sarcoidosis. Three of our sarcoidosis patients developed significant steroid side effects but refused standard alternatives, fearing further complications. They found internet references to the use of doxycycline and pentoxifylline in sarcoidosis and requested their use. The results of their therapy are presented here.
METHODS: Data on disease activity, physiologic function and anthropometrics were obtained from PFT records and patient charts. The treatment regimen was pentoxifyllin 400mgPO BID and doxycycline 100mgPO BID.
RESULTS: All 3 patients have had sarcoidosis requiring more than 30 mg/day of prednisone for 10 years or more. They have consistently refused adjuvant regimens and outside referral. 1) A 59 year old woman developed obesity and sleep apnea on 60 mg/day of prednisone. She began pentoxifylline/doxycycline in April, 2007. Her prednisone dose is now 10 mg/day with stable pulmonary function. 2) A 53 year old woman using prednisone 40 mg/day began pentoxifylline/doxycycline in March 2007 because of diabetes. She has been off prednisone since February with no suggestion of disease activity. 3) A 49 year old woman on more than 30 mg/day of prednisone for 20 years developed diabetes and CMV pneumonia. She began doxycycline/pentoxifylline in September 2007 and has now been off prednisone for 2 months with stable pulmonary function. ACE levels, high in all 3 patients during disease previously, are normal. None has reported treatment side effects.
CONCLUSION: This regimen reduces corticosteroid requirements in sarcoidosis with little treatment complication .
CLINICAL IMPLICATIONS: This regimen should be considered when sarcoidosis patients develop steroid complications but refuse standard regimens. Many patients will find similar treatment options on the internet, and physicians must be able to discuss them meaningfully.
DISCLOSURE: William Marino, No Financial Disclosure Information; No Product/Research Disclosure Information