PURPOSE: In this ten years follow up study analyses the efficiency of orally administered methotrexate as the steroid sparing agent or single agent in the treatment of patients with chronic sarcoidosis.
METHODS: 914 biopsy positive sarcoidosis patients were analyzed. Out of this group 139 patients were treated with low doses methotrexate due to the chronic course of pulmonary and extra pulmonary sarcoidosis. 128 patients had lung sarcoidosis and 80 patients extra pulmonary sarcoidosis including: eye sarcoidosis 50 patients, skin 40 patients, heart 15 patients, liver 10 patients, spleen 6 patients, bone disease 7 patients, lymph nodes involvement 7 patients, thyroid gland 4 patients, neurosarcoidosis 14 patients, and bone marrow 3 patients. Out of the whole group 52 patients were treated with methotrexate only, and 87pts were treated with corticosteroids at the same time. The complete respond to the therapy was defined as the improvement of the chest X ray and the improvement of the clinical symptoms and signs of extra pulmonary disease.
RESULTS: Chest X ray improvement occurred in 80% of patients after 6 months of treatment: 70% of patients receiving prednisolone at the same time decreased daily steroid dose to 10 to 5 mg. First improvement of extrapulmonary disease was noticed 6 months after initiation of the therapy. The extreme respond was noticed in two cases of neurosarcoidosis with hydrocephalus 7 years after the first administration of methotrexate into the treatment.Patients, who experienced relapse of sarcoidosis after the therapy, were re treated successfully with methotrexate again. (25 patients). 26 patients are off the therapy and did not experience the relapse of sarcoidosis after 5–10 years of follow.
CONCLUSION: Low doses of orally administered methotrexate were well tolerated. During the therapy no adverse effects needed the discontinuation of methotrexate were noticed.
CLINICAL IMPLICATIONS: Low doses of orally administered methotrexate are highly recommended in the therapy of chronic sarcoidosis for its low side effects as the single agent or steroid sparing agent in the therapy of chronic sarcoidosis.
DISCLOSURE: Violeta Vucinic, No Financial Disclosure Information; No Product/Research Disclosure Information