Methotrexate (MTX) as a single agent for treating chronic, progressive sarcoidosis

OBJECTIVE : Steroid treatment of sarcoidosis is associated with significant morbidity and has often been disappointing. Our objective was to evaluate the efficacy and safety of monotherapy with MTX in chronic sarcoidosis patients. METHODS : Between 2005 and 2013 MTX was used as a monotherapy in 53 patients (pts) (F:22, M: 31) with progressive disease. The dose ranged from 7,5mg to 20mg weekly. In 9 cases MTX was the first line therapy. 44 pts (83%) were refractory after steroid treatment. RESULTS : The duration of treatment ranged from 3 to 25 months. The subjective intolerance was seen in 4pts. No severe adverse effects were observed in any case. The symptomatic improvement was seen in 27pts (51%). The objective improvement was noted in: 27 pts (51%)- radiological improvement 23 pts (43%)- PFT and 6MWT improvement 6 pts (11%) had extra thoracic lesions reduction In 12 pts (23%) progression of sarcoidosis was observed and steroid therapy was introduced. In 7 patients sarcoidosis relapsed after MTX being withdrawn. The concomitant infection was the reason of discontinuation of therapy in 4 patients. 5 severe complication of sarcoidosis developed after the MTX therapy was finished: 2 cases of invasive aspergillosis (one fatal), 2 fatal cases of cardiovascular complications and 1 case of HCV infection. CONCLUSION: MTX as a single agent has proved to be safe and effective steroid alternative in selected sarcoidosis patients with chronic progressive sarcoidosis. Chronic progressive sarcoidosis is often associated with other comorbidities that may complicate the treatment. There is need to search for selection criteria to determine who may benefit from monotherapy with MTX.