| Abstract | BACKGROUND: Immunosuppressive and cytotoxic agents have been used as both an alternative to oral corticosteroids, and as a means of maintaining a low dose of steroids in the treatment of pulmonary sarcoidosis. OBJECTIVES: To determine the efficacy of immunosuppressive and cytotoxic agents in the treatment of pulmonary sarcoidosis. SEARCH STRATEGY: CENTRAL, MEDLINE, EMBASE and CINAHL were searched for possible randomised trials and bibliographies were checked for other potentially relevant trials. Searches were current as of April 2006. SELECTION CRITERIA: Randomised controlled trials comparing an immunosuppressive or cytotoxic therapy with a control in patients with pulmonary sarcoidosis were included in the review. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data for entry in to the RevMan 4.2. Pharmaceutical companies and study investigators were contacted for unpublished trials. MAIN RESULTS: Five studies were included in the review. Trials comparing methotrexate, chloroquine, cyclosporin A and pentoxifylline were identified. No data could be combined for a meta-analysis. Data on lung function, chest x-ray scores and dyspnoea were largely inconclusive. Adverse effects were associated with methotrexate, cyclosporin A, chloroquine and pentoxifylline. In two small studies methotrexate and pentoxifylline were associated with a steroid sparing effect. In the methotrexate study this was apparent after 12 months of therapy, but no difference was observed at 6 months. AUTHORS' CONCLUSIONS: The current body of evidence supporting the use of immunosuppressive agents and cytotoxic therapies is limited. Side-effects associated with some of the therapies were severe. |
| Authors | S Paramothayan, T J Lasserson, E H Walters |
| Journal | Cochrane database of systematic reviews (Online)
(Cochrane Database Syst Rev)
Vol. 3
Pg. CD003536
( 2006)
ISSN: 1469-493X England |
| PMID | 16856012
(Publication Type: Journal Article, Review)
|
| Chemical References |
- Antineoplastic Agents
- Immunosuppressive Agents
- Prednisone
- Chloroquine
- Methotrexate
- Cyclosporine
- Pentoxifylline
|
| Topics |
- Antineoplastic Agents
(adverse effects, therapeutic use)
- Chloroquine
(therapeutic use)
- Cyclosporine
(therapeutic use)
- Humans
- Immunosuppressive Agents
(adverse effects, therapeutic use)
- Methotrexate
(therapeutic use)
- Pentoxifylline
(therapeutic use)
- Prednisone
(therapeutic use)
- Randomized Controlled Trials as Topic
- Sarcoidosis, Pulmonary
(drug therapy)
|
