Please use this identifier to cite or link to this item:
Title: Methotrexate vs Azathioprine in Second-line Therapy of Sarcoidosis
Authors: Vorselaars, Adriane D. M.
Wuyts, Wim A.
Vorselaars, Veronique M. M.
Zanen, Pieter
Deneer, Vera H. M.
Veltkamp, Marcel
Thomeer, Michiel 
van Moorsel, Coline H. M.
Grutters, Jan C.
Issue Date: 2013
Source: CHEST, 144 (3), p. 805-812
Abstract: Background: Steroids remain the first-choice therapeutic in sarcoidosis; however, long-term use is associated with toxicity. Evidence defining the best second-line therapeutic is currently lacking. The aim of this study was to compare the effect of methotrexate and azathioprine on prednisone tapering, pulmonary function, and side effects in the second-line treatment of sarcoidosis. Methods: An international retrospective cohort study was performed, reviewing all patients with sarcoidosis who started methotrexate or azathioprine until 2 years after initiation or discontinuation. A linear mixed model with FEV1, vital capacity (VC), diffusing capacity of lung for carbon monoxide (D-LCO), and prednisone dose changes over time as end points was used. Side effects were compared with x 2 tests. Results: Two hundred patients were included, of whom 145 received methotrexate and 55 azathioprine. Prednisone daily dose decreased a mean of 6.32 mg/y (P<.0001) while on therapy, with a similar steroid-sparing capacity for methotrexate and azathioprine. Of all patients completing 1 year of therapy, 70% had a reduction in daily prednisone dose of at least 10 mg. FEV1 showed a mean increase of 52 mL/y (P = .006) and VC of 95 mL/y (P = .001) in both treatment groups. D-LCO % predicted increased, with a mean of 1.23%/y (P = .018). There were more patients with infections in the azathioprine group (34.6% vs 18.1%, P = .01), but no differences regarding other side effects. Conclusions: This retrospective study comparing the effect of second-line therapy in sarcoidosis shows that both methotrexate and azathioprine have significant steroid-sparing potency, a similar positive effect on lung function, and comparable side effects, except for a higher infection rate in the azathioprine group.
Notes: [Vorselaars, Adriane D. M.; Vorselaars, Veronique M. M.; Veltkamp, Marcel; van Moorsel, Coline H. M.; Grutters, Jan C.] St Antonius Hosp, Dept Pulmonol, Ctr Interstitial Lung Dis, NL-3435 CM Nieuwegein, Netherlands. [Deneer, Vera H. M.] St Antonius Hosp, Dept Clin Pharm, NL-3435 CM Nieuwegein, Netherlands. [Wuyts, Wim A.] Univ Hosp Leuven, Dept Pulmonol, Unit Interstitial Lung Dis, Louvain, Belgium. [Zanen, Pieter; van Moorsel, Coline H. M.; Grutters, Jan C.] Univ Med Ctr Utrecht, Div Heart & Lungs, Utrecht, Netherlands. [Thomeer, Michiel] UHasselt, Hosp Oost Limburg, Res Cluster Oncol, Dept Resp Med, Hasselt, Belgium.
Keywords: critical care medicine; respiratory system
Document URI:
ISSN: 0012-3692
e-ISSN: 1931-3543
DOI: 10.1378/chest.12-1728
ISI #: 000326161700017
Category: A1
Type: Journal Contribution
Validations: ecoom 2014
Appears in Collections:Research publications

Files in This Item:
File Description SizeFormat 
AZA.pdf760.87 kBAdobe PDFView/Open
Show full item record


checked on Sep 2, 2020


checked on May 13, 2022

Page view(s)

checked on May 18, 2022


checked on May 18, 2022

Google ScholarTM



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.