S Paramothayan1, T Lasserson, E H Walters. 1. Respiratory Medicine, Kingston Hospital NHS Trust, Galsworthy Rd, Kingston Upon Thames, Surrey, UK, KT2 7QB.
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 Pharmaceutical companies and study investigators were contacted for unpublished trials.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.
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: Sankar D Navaneethan; Sundar Venkatesh; Rakesh Shrivastava; Jagat Mehta; Robert Israel Journal: PLoS Med Date: 2005-03-29 Impact factor: 11.069
Authors: Mohamed A Abdallah; Moataz Ellithi; Rakshya Sharma; Arwyn Cunningham; Hamza Tantoush Journal: J Investig Med High Impact Case Rep Date: 2019 Jan-Dec