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Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis
S Paramothayan1, T Lasserson, E H Walters
1Respiratory Medicine, Kingston Hospital NHS Trust, Galsworthy Rd, Kingston Upon Thames, Surrey, UK, KT2 7QB.
Background:
Immunosuppressive and cytotoxic agents have been used as both an alternative to oral corticosteroids, and as a means of maintaining a low dose of steroids in the treatment of pulmonary sarcoidosis.
Objectives:
To determine the efficacy of immunosuppressive and cytotoxic agents in the treatment of pulmonary sarcoidosis.
Search Strategy:
The Cochrane Airways Group trials register was searched for possible randomised trials. Bibliographies were searched for other potentially relevant trials. Searches were current as of February 2001.
Selection Criteria:
Randomised controlled trials comparing an immunosuppressive or cytotoxic therapy with a control in patients with pulmonary sarcoidosis were included in the review.
Data Collection And Analysis:
Two reviewers independently extracted data for entry in to the Review Manager statistical package (MetaView 4.1). Pharmaceutical companies and study investigators were contacted for unpublished trials.
Main Results:
Four studies were included in the review. Trials comparing methotrexate, chloroquine and cyclosporin A were identified. No data could be combined for a meta-analysis. Data on lung function, chest x-ray scores and dyspnoea were largely inconclusive. Adverse effects were associated with methotrexate, cyclosporin A and chloroquine. In one small study, methotrexate was associated with a steroid sparing effect after 12 months of therapy, but no difference was observed at 6 months.
Reviewer'S Conclusions:
The current body of evidence supporting the use of immunosuppressive agents and cytotoxic therapies is limited. Side-effects associated with some of the therapies were severe.