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. 2006 Jul 19;2006(3):CD003536.
doi: 10.1002/14651858.CD003536.pub2.

Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis

S Paramothayan, T J Lasserson, E H Walters

Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis

S Paramothayan et al. Cochrane Database Syst Rev. .

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 Pharmaceutical companies and study investigators were contacted for unpublished trials.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.

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Conflict of interest statement

None known.

Figures

1.2
1.2. Analysis
Comparison 1 Cyclosporin A plus prednisone versus prednisone alone, Outcome 2 Clinical improvement in pulmonary function.
1.4
1.4. Analysis
Comparison 1 Cyclosporin A plus prednisone versus prednisone alone, Outcome 4 Adverse effects ‐ newly diagnosed hypertension.
1.5
1.5. Analysis
Comparison 1 Cyclosporin A plus prednisone versus prednisone alone, Outcome 5 Withdrawal due to adverse effects.
1.6
1.6. Analysis
Comparison 1 Cyclosporin A plus prednisone versus prednisone alone, Outcome 6 Adverse events ‐ chest infection.
2.1
2.1. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 1 FEV1 decline rate (ml/year).
2.2
2.2. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 2 FVC decline rate (ml/year).
2.3
2.3. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 3 DLco‐SB decline rate (mm Hg/min/year).
2.4
2.4. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 4 Dyspnoea at 1 month.
2.5
2.5. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 5 Dyspnoea at 2 months.
2.6
2.6. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 6 Dyspnoea at 4 months.
2.7
2.7. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 7 Dyspnoea at 6 months.
2.8
2.8. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 8 Dyspnoea at 12 months.
2.9
2.9. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 9 Chest X‐ray scores at 4 months (including all participants).
2.10
2.10. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 10 Chest X‐ray scores at 6 months (including all participants).
2.11
2.11. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 11 Chest X‐ray scores at 12 months (including all participants).
2.12
2.12. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 12 Side effects (self reported).
2.13
2.13. Analysis
Comparison 2 Chloroquine versus placebo, Outcome 13 Treatment failure.
3.3
3.3. Analysis
Comparison 3 Methotrexate plus prednisone versus placebo plus prednisone, Outcome 3 Adverse effects ‐ respiratory infections.
3.4
3.4. Analysis
Comparison 3 Methotrexate plus prednisone versus placebo plus prednisone, Outcome 4 Reduction in dose of methotrexate (or placebo) due to adverse effects.
4.1
4.1. Analysis
Comparison 4 Pentoxifylline plus corticosteroids versus placebo plus corticosteroids, Outcome 1 Recurrence of sarcoidosis.
4.2
4.2. Analysis
Comparison 4 Pentoxifylline plus corticosteroids versus placebo plus corticosteroids, Outcome 2 Adverse effects.
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