Patient reported side-effects of prednisone and methotrexate in a real-world sarcoidosis population.

Vivienne Kahlmann,Marcel Veltkamp,Catharina C Moor,Marlies S Wijsenbeek

doi:10.1177/14799731211031935

Vivienne Kahlmann, Marcel Veltkamp + Show 2 more

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https://doi.org/10.1177/14799731211031935

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Abstract

Currently prednisone is the first-line pharmacological treatment option for pulmonary sarcoidosis. Methotrexate is used as second-line therapy and seems to have fewer side-effects. No prospective comparative studies of first-line treatment with methotrexate exist. In this study, we evaluated patient reported presence and bothersomeness of side-effects of prednisone and methotrexate in a sarcoidosis population to guide the design of a larger prospective study. During a yearly patient information meeting 67 patients completed a questionnaire on medication use; 11 patients never used prednisone or methotrexate and were excluded from further analysis. Of the remaining 56 patients, 89% used prednisone and 70% methotrexate (present or former). Significantly more side-effects were reported for prednisone than for methotrexate, 78% versus 49% (p = 0.006). In conclusion, methotrexate seems to have fewer and less bothersome side-effects than prednisone. These findings need to be confirmed in a prospective study.

Highlights

Sarcoidosis is a granulomatous disease with a heterogeneous presentation
Treatment aims at improving organ function, as well as quality of life (QoL).[2]
Prednisone often has major side-effects, such as weight gain, depression, osteoporosis and diabetes, which may lead to impaired QoL.[4,5,6]

Summary

Introduction

The lungs are involved in over 75% of patients[1] The decision to start treatment depends on different factors, such as the threat on organ function and symptom severity. Treatment aims at improving organ function, as well as quality of life (QoL).[2] Prednisone is currently the first-line pharmacological treatment option in pulmonary sarcoidosis. Prednisone leads to short-term improvement of pulmonary function and symptoms.[3] prednisone often has major side-effects, such as weight gain, depression, osteoporosis and diabetes, which may lead to impaired QoL.[4,5,6] patients and doctors report an urgent need for better treatment options. Methotrexate is presently considered second-line therapy and has not been studied as first-line treatment.3,7Methotrexate may have fewer side-effects than prednisone.

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