Algorithm of treatment of patients with pulmonary sarcoidosis
Journal Title: Український терапевтичний журнал - Year 2018, Vol 0, Issue 1
Abstract
Objective — to develop the algorithm of treatment of patients with pulmonary sarcoidosis, based on the data regarding the rate of contraindications, adverse reactions and resistance to glucocorticosteroids (GCS) and the choice of the optimal drug for immunosuppressive therapy. Materials and methods. The study involved 185 patients with newly diagnosed lung parenchyma sarcoidosis to investigate the rate of contraindications, adverse reactions and resistance to GCS was conducted. The comparative study of azathioprine, leflunomide and methotrexate efficacy was performed in 43 pulmonary sarcoidosis patients. Results and discussion. At average, every eighth patient with stage II—III pulmonary sarcoidosis (12.4 %) required the administration of immunosuppressive therapy immediately after the diagnosis established due to contraindications for GCS use. During the course of GCS treatment, the necessity to use immunosuppressive drugs increases due to development of serious side effects or resistance in up to 32.4 % of patients. That is, every third patient in different phases of treatment would require immunosuppressant drugs. In majority of patients with GSC contraindications/serious side effects, an alternative therapy with azathioprine 50 mg/day with subsequent elevation of daily dose on 25 mg/day every 2 weeks (until maximum dose reached) was not effective. The use of leflunomide (20 mg/day) increased the rate of regression of sarcoidosis after 3 months of the therapy by 50 %. Unlike azathioprine and leflunomide, methotrexate (10 mg/week) was effective in the most part of patients (73,7 %). Methotrexate had more favorable safety profile. In comparison with azathioprine and leflunomide there were no serious side effects registered during 3 months of therapy with methotrexate (10 mg/week). Conclusions. An algorithm of therapy of patients with sarcoidosis has been created, based on the taking into account the contraindications, adverse reactions and resistance to GCS and the use of methotrexate as immunosuppressive medication with optimal efficacy and safety properties.
Authors and Affiliations
V. K. Gavrysyuk, E. О. Merenkova, G. L. Gumeniuk, O. V. Bychenko
Keywords
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