Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/17227
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
Publisher: AMER COLL CHEST PHYSICIANS
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: http://hdl.handle.net/1942/17227
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

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