High-dose methylprednisolone pulse therapy in sarcoidosis

Intravenous methylprednisolone in "pulse" dose (30 mg/kg, once a week for 6 weeks) with or without oral maintenance corticosteroid therapy was administered to 12 patients with chronic sarcoidosis. Disease activity was evaluated by broncho-alveolar lavage, serum angiotensin converting enzyme assay and 67Ga scanning. Efficacy was assessed by clinical, radiological, and functional data. Pulse methylprednisolone produced immediate improvement in all patients but eight of the 12 patients relapsed 1 year later; one patient without maintenance corticosteroids and three patients with maintenance oral corticosteroids showed persistent improvement. However, there was no significant difference in criteria of disease activity of each patient before pulse therapy and 1 year later (p greater than 0.5). In conclusion, high dose therapy has immediate but transient effects whether or not it is supplemented by conventional corticosteroid therapy at the lower maintenance dosage.