Comparative analysis of sarcoidosis treatment efficiency in clinical practice settings

Aim. To evaluate the effectiveness of different management regimens in patients with sarcoidosis in clinical practice settings.

Methods. A retrospective analysis of condition of 530 patients with sarcoidosis at baseline and at the end of follow-up (at least 6 months) was conducted. The patients were divided into subgroups according to the treatment received by them: prednisolone, methotrexate, pentoxifylline, vitamin E. The fifth group consisted of patients who were under active surveillance without treatment. The dynamics of the disease clinical and laboratory manifestations, radiographic changes, and lungs forced vital capacity were evaluated.

Results.. Improvement rate was the highest and amounted to 74.3% in patients with mild forms of sarcoidosis treated with vitamin E. The spirometric parameters have most commonly positive dynamics among patients treated with prednisone (56.2%). When comparing patients with equal radiographic stages and close spirometry data, methotrexate improved radiographic pattern in 70% of cases. Pentoxifylline effect was associated with the initial radiographic stages of sarcoidosis (p=0.003), its influence was insufficient in preventing of the fibrosis development and the lungs vital capacity reduction in patients with initially severe and widespread forms of sarcoidosis. After completion of treatment with methotrexate, relapse occurred in 37.2% of patients, and after pentoxifylline treatment in 31% of cases subsequent systemic glucocorticoid therapy was needed.

Conclusion. In mild sarcoidosis vitamin E is quite effective and active surveillance without treatment is acceptable, in case of severe course, prednisolone and methotrexate efficacy is comparable, while pentoxifylline did not allow to prevent fibrosis development and the lungs ventilatory capacity reduction; choice of regimen is determined by the clinical presentation severity and lesion size according to the X-ray.