Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis.

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:

The Cochrane Airways Group trials register was searched for possible randomised trials. Bibliographies were searched for other potentially relevant trials. Searches were current as of February 2001.

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 Review Manager statistical package (MetaView 4.1). Pharmaceutical companies and study investigators were contacted for unpublished trials.

MAIN RESULTS:

Four studies were included in the review. Trials comparing methotrexate, chloroquine and cyclosporin A 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 and chloroquine. In one small study, methotrexate was associated with a steroid sparing effect after 12 months of therapy, but no difference was observed at 6 months.

REVIEWER'S 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 Lasserson, E H Walters
• Journal: The Cochrane database of systematic reviews (Cochrane Database Syst Rev) Issue 3 Pg. CD003536 ( 2003) ISSN: 1469-493X [Electronic] England
• PMID: 12917971 (Publication Type: Journal Article, Review, Systematic Review)

Chemical References

• Antineoplastic Agents
• Immunosuppressive Agents
• Cyclosporine
• Chloroquine
• Methotrexate

Topics

• Antineoplastic Agents (adverse effects, therapeutic use)
• Chloroquine (therapeutic use)
• Cyclosporine (therapeutic use)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Methotrexate (therapeutic use)
• Randomized Controlled Trials as Topic
• Sarcoidosis, Pulmonary (drug therapy)