REFRACTORY PULMONARY SARCOIDOSIS: INCIDENCE AFTER TREATMENT WITH METHYLPREDNISOLONE AND/OR METHOTREXATE IN PATIENTS WITH NEWLY DIAGNOSED DISEASE.

ABSTRACT

Pulmonary sarcoidosis is considered refractory if glucocorticoids (GCs) at a maintenance dose of at least 10 mg/day (prednisolone equivalent) and methotrexate (MTX), including their combined use, are not effective enough to achieve clinical remission. Aim - to study the rate of refractory pulmonary sarcoidosis after conventional treatment with methylprednisolone (MP) and/or MTX in patients with newly diagnosed disease. 250 patients with newly diagnosed pulmonary sarcoidosis (106 men and 144 women; mean age 44 years) were examined. Radiological stage II was established in 237 (94.8%) patients, stage III - in 13 (5.2%). GCs therapy was carried out using MP in 190 patients at an initial dose of 0.4 mg/kg/day for 4 weeks with a gradual decrease to a maintenance dose (0.1 mg/kg/day) by the end of the 6th month. In the presence of contraindications or serious adverse effects of MP (60 patients), MTX was used at a dose of 15 mg/week. Patients without contraindications and serious adverse effects of MP treated with MTX, in case of initial therapy failure, were prescribed combined therapy with MP (12 mg/day) and MTX (10 mg/week). Based on combination therapy outcomes, as well as taking into account the cases of MTX therapy failure in patients with contraindications or serious adverse effects of GCs therapy, refractory pulmonary sarcoidosis was diagnosed in 27 (10.8%) patients. Patients with refractory pulmonary sarcoidosis were more likely to have stage III disease (Pearson's χ2 test=5.766, p=0.018), as well as extrapulmonary lesions (χ2 test=4.672, p=0.031). The high rate of conventional therapy failure using first- and second-line medications in patients with newly diagnosed sarcoidosis determines the relevance of further study of the causes, development of risk criteria and new approaches to the treatment of refractory pulmonary sarcoidosis.