Diffuse Lung Disease |

Antifungal Treatment in Sarcoidosis: A Comparison With Corticosteroids FREE TO VIEW

Marjeta Tercelj, PhD; Barbara Salobir, PhD; Mirjana Zupancic, PhD; Ragnar Rylander, PhD
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University Medical Clinical Centre, Ljubljana, Slovenia

Chest. 2014;145(3_MeetingAbstracts):245A. doi:10.1378/chest.1822865
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Several clinical and case studies show that short-term treatment with anti-fungal medication improved the clinical status of the disease. To further explore this, a study was undertaken where treated patients were followed till healing of the disease.

METHODS: During 2006 till 2012 years patients were admitted to our hospital with newly diagnosed sarcoidosis (stage II, n = 45 and stage III, n = 3). After an expectation time of three months to avoid spontaneous regression, they were given corticosteroids (metilprednisolon, n = 20) or anti-fungal medication (itraconasol (200 mg daily or posaconasol 200 mg daily, n = 21). Seven patients were given both drugs immediately in view of the severity of the disease. Chest X-rays were taken to determine the degree of granuloma infiltration in the lung parenchyma as a score. The patients were followed with chest x-ray and citotriosidase (CTO) and angiotensin converting enzyme (ACE) were determined in serum. The time till clinical healing of the disease was recorded as well as the number of recurrences.

RESULTS: The time till healing was 11.9 months for those with anti-fungal treatment and 13.7 months for corticosteroid (NS). Regarding chest x-ray scores, there was no difference between the groups at diagnosis. At six months after initiation of treatment and at healing, the granulomatous infiltration was significantly less severe among those with anti-fungal medication (p=0.025 and 0.003 respectively). The number of recurrencies was also lower in the anti-fungal group (1 vs 7, p=0.006). Some patients had slightly elevated transaminase values as a side effect of anti-fungal medication.

CONCLUSIONS: The presence of subjects with more severe disease who were given both medications suggests that the efficiency of anti-fungal treatment may be limited to the less severe forms of the disease. In spite of this, the results suggest that anti-fungal medication could be an alternative in the treatment of sarcoidosis, thus avoiding the side-effects of corticosteroid treatment.

CLINICAL IMPLICATIONS: The results suggest that anti-fungal medication could be an alternative in the treatment of sarcoidosis.

DISCLOSURE: The following authors have nothing to disclose: Marjeta Tercelj, Barbara Salobir, Mirjana Zupancic, Ragnar Rylander

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