Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis.

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 Pharmaceutical companies and study investigators were contacted for unpublished trials.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