Long-term outcomes of combination therapy with methotrexate and methylprednisolone in patients with pulmonary sarcoidosis

Abstract

Recently, the combination therapy with methotrexate (MTX) and glucocorticosteroids (GC) is getting more importance in patients with pulmonary sarcoidosis. Aim – to study the rate of relapses of pulmonary sarcoidosis after completion of combination therapy with MTX and methylprednisolone (MP). <b>Methods:</b> We examined 30 patients with pulmonary sarcoidosis. Among them there were 28 patients with radiological stage II and 2 patients with stage III of sarcoidosis; male – 11, female – 19, age – from 24 to 66 years. All patients were examined using standard clinical laboratory tests, chest computed tomography, spirometry. Patients were administered combination of MP 12 mg daily with MTX 10 mg once a week. Before start of combination therapy all patients received MP 24 mg daily at least one month with tapering by 2 mg per month to maintenance dose of 8 mg. MTX in dose 10 mg weekly was co-administered because GC-therapy was not associated with regression of sarcoid lesions on CT scan. Mean duration of combination therapy was 13 months. Long-term outcomes were evaluated in 6, 12 and 24 months after completion of therapy. <b>Results:</b> We registered 21 relapses, whereas stable remission was noted in only 9 patients. 19 relapses occurred within 1 year upon completion of therapy. In 2 patients the relapse has been registered in 1,5 years after completion of treatment. In this way, the rate of relapses after combination therapy was 70 %. <b>Conclusion:</b> Combination therapy with MP and MTX in refractory pulmonary sarcoidosis was associated with high rate of diseases relapses, which could be explained both by severity of disease and use of GC medications.