Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis

Paramothayan, Shanthi; Lasserson, TJ; Walters, EH

doi:10.1002/14651858.cd003536

Cited by 23 publications

(30 citation statements)

References 30 publications

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“…Despite many years of using steroids, there remains little consensus on initiating or maintenance dose schedules, treatment of symptomatic patients, duration of treatment, long-term benefit, steroid-sparing alternatives or combinations 104 105. A steroid regimen might initially consist of 30–40 mg of prednisolone daily,1 95 100 106 falling in stages over a 2-month period to a maintenance dose of 10–15 mg per day 11.…”

Section: Managementmentioning

confidence: 99%

“…Immunosuppressive (ie, chloroquine, hydroxychloroquine, ciclosporin A, azathioprine, thalidomide, leflunomide, pentoxifylline and mycophenolate mofetil) and cytotoxic therapies (ie, methotrexate and cyclophosphamide)110 111 are used as alternatives to, or as a means of reducing, the overall steroid dose 100 105 106 112 113. Data on their use in cardiac sarcoidosis are limited, but overall, the most studied alternative to steroids is methotrexate,105 although cardiac efficacy is not established 114.…”

Section: Managementmentioning

confidence: 99%

“…Data on their use in cardiac sarcoidosis are limited, but overall, the most studied alternative to steroids is methotrexate,105 although cardiac efficacy is not established 114. Recently, a multinational group has indicated that 80% of physicians consider methotrexate a first choice second-line treatment 115 116.…”

Section: Managementmentioning

confidence: 99%

“…Cyclophosphamide has significant toxicity, but has shown some success in cardiac sarcoidosis 111 117. The evidence remains limited,105 with no randomised controlled trials to support one treatment over another 11…”

Section: Managementmentioning

confidence: 99%

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Cardiac sarcoidosis: diagnosis and management

Dubrey

Sharma

Underwood

et al. 2015

Postgraduate Medical Journal

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Cardiac sarcoidosis is one of the most serious and unpredictable aspects of this disease state. Heart involvement frequently presents with arrhythmias or conduction disease, although myocardial infiltration resulting in congestive heart failure may also occur. The prognosis in cardiac sarcoidosis is highly variable, which relates to the heterogeneous nature of heart involvement and marked differences between racial groups. Electrocardiography and echocardiography often provide the first clue to the diagnosis, but advanced imaging studies using positron emission tomography and MRI, in combination with nuclear isotope perfusion scanning are now essential to the diagnosis and management of this condition. The identification of clinically occult cardiac sarcoidosis and the management of isolated and/or asymptomatic heart involvement remain both challenging and contentious. Corticosteroids remain the first treatment choice with the later substitution of immunosuppressive and steroid-sparing therapies. Heart transplantation is an unusual outcome, but when performed, the results are comparable or better than heart transplantation for other disease states. We review the epidemiology, developments in diagnostic techniques and the management of cardiac sarcoidosis.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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Cardiac sarcoidosis: diagnosis and management

Dubrey

Sharma

Underwood

et al. 2015

Postgraduate Medical Journal

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“…Recent studies and reviews continue to be sceptical about the long-term use of steroids, or alternative immunosuppressive therapies, in the management of sarcoid disease 6. The fluid retention in our patient on receiving steroid therapy is indicative of the severe side effects associated with the immunosuppressive and cytotoxic therapies currently available 7…”

Section: Discussionmentioning

confidence: 96%

A patient with a red eye and pulmonary oedema

et al. 2014

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SUMMARYA middle-aged black male patient presented with symptoms and radiological features indicative of pulmonary oedema. Following several admissions for the same symptomology, and poor resolution of chest radiographic features, the patient developed a red eye. The latter was diagnosed as uveitis, which prompted consideration and proof of a diagnosis of cardiopulmonary sarcoidosis. The patient was subsequently treated with high dose steroids resulting in a partial recovery, complicated by issues of fluid retention. BACKGROUND

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Treatments for pulmonary sarcoidosis

Paramothayan

Lasserson

2008

Respiratory Medicine

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Corticosteroids (oral or inhaled) are commonly used to treat pulmonary sarcoidosis; however, there is no consensus about when to start treatment, what dose of steroids to give and for how long. Immunosuppressive and cytotoxic agents (used in immunosuppressive doses) are used in addition to oral corticosteroids to treat multisystem and chronic sarcoidosis, or as steroid-sparing agents. We summarize the findings from two Cochrane systematic reviews that have examined the efficacy of corticosteroids and immunosuppressive and cytotoxic drugs in the treatment of pulmonary sarcoidosis. Studies of corticosteroids differed in outcome measures, dose of drug given and length of treatment. For many outcome measures, data could not be pooled for meta-analysis. Oral corticosteroids improved chest X-ray appearance over 3-24 months, with improvement in global score in one study. Little evidence was found of improvement in lung function or of any long-term disease-modifying effect. Follow-up data could not be analysed. Inhaled corticosteroids improved symptoms in one small study but not lung function or chest X-ray. Side-effects of steroids were not well reported. In the immunosuppressive and cytotoxics review, no data could be combined for meta-analysis. Data on lung function, chest X-ray and dyspnoea were largely inconclusive. Methotrexate had a steroid-sparing effect in one small study. Significant adverse events were associated with cyclosporine A, chloroquine and pentoxifylline. Evidence from randomized-controlled trials (RCTs) supporting the use of immunosuppressive and cytotoxic agents is limited.

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Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis

Cited by 23 publications

References 30 publications

Cardiac sarcoidosis: diagnosis and management

Cardiac sarcoidosis: diagnosis and management

A patient with a red eye and pulmonary oedema

Treatments for pulmonary sarcoidosis

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