Evaluation of the efficacy and safety of methotrexate in progressive sarcoidosis: a retrospective observational study

Abstract

Sarcoidosis is epithelioid cell granulomatosis of unknown etiology. All the schemes of its treatment are of a recommendatory nature. Methotrexate (MTT) is considered a second-line drug in the treatment of sarcoidosis.Methods. A retrospective observational study of patients with progressive sarcoidosis (n = 104), treated with MTT once a week, was carried out. Clinical, laboratory, functional and radiation parameters were evaluated with an interval of 3 months ≤ 1 year.Results. The use of MTT was accompanied by an improvement in the radiation picture (64.1% by the end of the year), an improvement not only in spirometry parameters, starting from the 3rd month (54.7%), but also in the general condition of the patients (63.8% – at the 6th month). Adverse reactions with drug withdrawal were most often observed (15.4%) during the first 3 months, and subsequently their frequency decreased.Conclusion. According to the results of the study, it was shown that methotrexate can be recommended for further use in progressive sarcoidosis, as well as in patients, who have previously received systemic glucocorticosteroids.

Efficacy and Tolerability of Methotrexate and Methylprednisolone in a Comparative Assessment of the Primary and Long-Term Outcomes in Patients with Pulmonary Sarcoidosis

“…We believe that the literature data provided [22,23,30] and the results of our own MTX and MP efficacy and tolerability studies in patients with pulmonary sarcoidosis may be helpful for practicing pulmonologists in the objective assessment of the risk-benefit ratio in the case of relative contraindications or limitations to the use of CS therapy and they may choose the appropriate treatment agent.…”

“…The limitation for a wider MTX prescription in pulmonary sarcoidosis patients is due to a common perception among practicing pulmonologists that MTX, as opposed to CS, results in a less pronounced clinical effect and is associated with serious hepatotoxicity and haematotoxicity. In recent years, rebuttal clinical studies were conducted [22,23,30].…”

“…The results of a retrospective observational study in 1276 sarcoidosis patients conducted by Vizel', A.A. et al [30] allowed them to conclude that 15 mg MTX weekly per os in patients with advanced sarcoidosis who were previously on systemic CS is an effective second-line drug. The sufficient safety level of MTX allows its long-term prescription from 3 months to ≥ 1 year.…”