Prolonged Use of Methotrexate for Sarcoidosis

doi:10.1001/archinte.1995.00430080088011

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Vol. 155 No. 8, 24 APRIL 1995

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Prolonged Use of Methotrexate for Sarcoidosis

Elyse E. Lower, MD; Robert P. Baughman, MD

Arch Intern Med. 1995;155(8):846-851.

Abstract

Background
To determine the safety and efficacy of methotrexate as a steroid-sparingagent in patients with symptomatic sarcoidosis, a nonrandomizedinterventional study of patients with chronic sarcoidosis treatedwith methotrexate for at least 2 years was performed. Efficacywas assessed for all patients after 2 years of treatment. Toxicitywas assessed for all patients receiving therapy for the entiretime (a total of 150 patient-years).

Methods
Patients were treated in a subspecialty ambulatory clinic ata university hospital. Patients with biopsy-confirmed sarcoidosiswho had persistent symptoms and who were eager to avoid or reducecorticosteroid therapy were selected for study. A total of 50patients completed at least 2 years of methotrexate therapy.Patients were treated with oral methotrexate once a week. Dosagewas adjusted based on the patient's white blood cell count.Clinical response was measured in the affected organ, includingthe lung (measurement of vital capacity), skin (regression ofskin lesions), and central nervous system (magnetic resonanceimaging). Also noted was the initial and subsequent dosage ofprednisone used as therapy for sarcoidosis.

Results
Improvement in vital capacity or other affected symptomaticorgan was noted in 33 of 50 treated patients. Corticosteroidswere discontinued in an additional six patients who remainedstable with clinical or symptomatic improvement. The major toxiceffects noted in 150 patient-years of therapy were hepatic (sixpatients), leukopenia requiring hospitalization (one patient),and cough (one patient). Forty-one liver biopsy procedures wereperformed in 33 patients. Of these, six demonstrated significantchanges related to methotrexate that led to drug discontinuation.

Conclusion
Methotrexate is a well-tolerated therapeutic agent with significantsteroid sparing and efficacy for the treatment of chronic symptomaticsarcoidosis.

(Arch Intern Med. 1995;155:846-851)

Author Affiliations

From the Department of Internal Medicine, University of Cincinnati (Ohio) Medical Center.

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