Abstract 17849: Additional Use of Methotrexate Improved Clinical Findings and Metabolic Profile in Patients with Cardiac Sarcoidosis Refractory to Corticosteroids

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Background. Corticosteroids are indicated in cardiac sarcoidosis (CS). However, some patients worsen clinically despite corticosteroid treatment, and are suffering from steroid-related side effects. Methotrexate (MTX) is one of the most commonly used cytotoxic agents and has steroid-sparing effects for autoimmune diseases. Furthermore, aniti-inflammatory property of this agent may affect the pathogenesis of chronic heart failure. We hypothesized that MTX has a potential to improve clinical findings and reduce side effects of corticosteroids in patients with refractory CS. Methods. Out of 30 ambulatory CS patients treated with corticosteroids, we added MTX in combination with maintenance dose of corticosteroids for 7 patients who were suffering from relapse or deterioration and steroid-related side effects such as poorly controlled diabetes, osteoporosis or psychosis. All of the 7 were treated with 7.5mg of MTX once a week. A mean duration of corticosteroid treatment in the 7 patients was 61 months (32 to 95 months). Results. During a mean follow-up of 30 (12 to 46) months, no cardiac event and no major side effect occurred. The addition of MTX reduced maintenance steroid doses without further deterioration (8.3±3.4 to 6.4±2.2mg, p<0.05) during the follow-up periods. Although LVEF was not significantly increased, plasma BNP level was significantly decrease from 120±106 to 75±68pg/ml (p<0.05). There were significant improvements in diabetes (HbA1c:7.6±1.9 to 7.2±2.0%, p<0.05) and lipid profile (Triglyceride levels: 226±124 to 167±118mg/dl, p<0.05). Increased uptake of 99m Tc-sestamibi and decreased uptake of 67 Ga in the myocardium were clearly observed in 2 patients after the addition of MTX. Conclusion. MTX is safe and helpful in combination with corticosteroids improving clinical findings, allowing for lower steroid doses, and reducing side effects of corticosteroids in patients with CS.