Efficacy and tolerability of methotrexate at a dose of 15 mg/week and 10 mg/week in patients with pulmonary sarcoidosis

Authors

  • V.K. Gavrysyuk SE “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”, M. Amosova St., 10, Kyiv, 03038, Ukraine, Ukraine https://orcid.org/0000-0001-6942-4504
  • I.O. Merenkova SE “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”, M. Amosova St., 10, Kyiv, 03038, Ukraine http://orcid.org/0000-0003-1299-7058
  • G.L. Gumeniuk SE “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”, M. Amosova St., 10, Kyiv, 03038, Ukraine https://orcid.org/0000-0001-8160-7856
  • N.V. Pendalchuk SE “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”, M. Amosova St., 10, Kyiv, 03038, Ukraine https://orcid.org/0000-0001-7875-3561
  • N.D. Morska SE “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”, M. Amosova St., 10, Kyiv, 03038, Ukraine https://orcid.org/0000-0001-5255-8290
  • N.A. Vlasova SE “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”, M. Amosova St., 10, Kyiv, 03038, Ukraine http://orcid.org/0000-0002-7590-4704

DOI:

https://doi.org/10.26641/2307-0404.2021.4.248088

Keywords:

pulmonary sarcoidosis, methotrexate, efficacy, tolerability

Abstract

The objective of this study is to conduct a comparative study of the efficacy and safety of methotrexate (MT) at a dose of 10 mg/week and 15 mg/week in patients with pulmonary sarcoidosis having contraindications to GCS therapy. Material and Methods. The study involved 44 patients with stage II pulmonary sarcoidosis (26 females and 18 males aged 24 to 70) with contraindications to the appointment of therapy glucocorticosteroid (GCS). In group 1 (28 patients), methotrexate was prescribed at a dose of 10 mg/week, in group 2 (16 patients), methotrexate was prescribed at a dose of 15 mg/week. The diagnosis and assessment of the dynamics of sarcoidosis were carried out taking into account clinical symptoms based on the results of high-resolution computed tomography and body plethysmography. The significance of differences in indicators was determined using the Student's t-test and Fisher's exact test. The number of cases of clinical treatment without residual changes of a fibrous nature in the lung parenchyma in patients after treatment with methotrexate at a dose of 15 mg/week significantly increased compared to the same indicator in the group of patients after treatment at a dose of 10 mg/week (81.3% and 42.4% respectively, p=0.025). An increase in the therapeutic dose of methotrexate from 10 mg/week to 15 mg/week leads to a decrease in the time to achieve a clinical cure (10.1±0.5 months and 12.8±0.8 months respectively, р˂0.02), indicating an accelerating rate of regression of sarcoidosis. Immunosuppressive therapy of patients with pulmonary sarcoidosis using the drug at doses of 10 and 15 mg/week is characterized by satisfactory tolerability.

References

Vizel’ AA, Vizel’ IYu, Shakirova GR. [Evaluation of the efficacy and safety of methotrexate in progressive sarcoidosis: a retrospective observational study]. Pulmonologiya. 2020;30(2):213-8. Russian.

doi: https://doi.org/10.18093/0869-0189-2020-30-2-213-218

Golovanova IA, Bielikova IV, Liahova NO. [The basics of medical statistics: a textbook for graduate students and clinical residents]. Poltava; 2017. р. 113. Ukrainian.

Gavrysyuk VK, Merenkova EA, Gumeniuk GL, at al. [Effectiveness and safety of methotrexate monotherapy in patients with pulmonary sarcoidosis]. Georgian Medical News. 2018;10(283):34-38. Russian. Available from: https://cdn.website-editor.net/480918712df344a4a77508d4cd7815ab/files/uploaded/V283_N10_October_2018.pdf

Miller MR, et al. ATS/ERS Task Force. Standardisation of spirometry. Eur. Respir J. 2005;26(2):319-38. doi: http://doi.org/10.1183/09031936.05.00034805.

Fang C, Zhang Q, Wang N, et al. Effectiveness and tolerability of methotrexate in pulmonary sarcoidosis: A single center real-world study. Sarcoidosis Vasc. Diffuse Lung Dis. 2020;36(3):217-27. doi: https://doi.org/10.36141/svdld.v36i3.8449

Judson MA. The treatment of pulmonary sarcoidosis. Respir Med. 2012;106(10):1351-61. doi: https://doi.org/10.1016/j.rmed.2012.01.013

Korsten P, Strohmayer K, Baughman RP, Sweiss N. Refractory pulmonary sarcoidosis – proposal of definition and recommendation for the diagnostic and therapeutic approach. Clin Pulm Med. 2016;23(2):67-75. doi: http://doi.org/10.1097/CPM.0000000000000136

Baughman RP, Cremers JP, Harmon M, et al. Methotrexate in sarcoidosis: hematologic toxicity ehcountered in a large cohort over a six year period. Sarcoidosis Vasc. Diffuse Lung Dis. 2020;37(3):1-10. doi: https://doi.org/10.36141/svdld.v37i3.9362

Cremers JP, Drent M, Bast A, et al. Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide. Curr Opin Pulm Med. 2013;19(5):545-61. doi: https://doi.org/10.1097/MCP.0b013e3283642a7a

Schutt AC, Bullington AC, Judson MA. Pharmacotherapy for pulmonary sarcoidosis: a Delphi consensus study. Respir Med. 2010;104 (5):717-23. doi: https://doi.org/10.1016/j.rmed.2009.12.009

American Thoracic Society (ATS), European Respiratory Society (ERS), World Association of Sarcoidosis and Other Granulomatous Disoders (WASOG). Statement on Sarcoidosis. Am. J. Respir. Crit. Care Med. 1999;160:736-55.

doi: http://doi.org/10.1034/j.1399-3003.1999.14d02.x

Pietinalho A, Tukiainen P, Haahtela T, et al. Early treatment of study II sarcoidosis improves 5-year pulmo¬nary function. Chest. 2002;121:24-31. doi: http://doi.org/10.1378/chest.121.1.24

Veltkamp M, Grutters JC. The pulmonary manifestations of sarcoidosis. Pulmonary sarcoidosis: A Guide for the practicing clinician. MA Judson Ed. Humana Press, brand of Springer. 2014:19-40. Available from: https://link.springer.com/book/10.1007%2F978-1-4614-8927-6

Downloads

Published

2021-12-20

How to Cite

1.
Gavrysyuk V, Merenkova I, Gumeniuk G, Pendalchuk N, Morska N, Vlasova N. Efficacy and tolerability of methotrexate at a dose of 15 mg/week and 10 mg/week in patients with pulmonary sarcoidosis. Med. perspekt. [Internet]. 2021Dec.20 [cited 2024Dec.27];26(4):56-61. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/248088

Issue

Vol. 26 No. 4 (2021)

Section

CLINICAL MEDICINE

License

Copyright (c) 2021 Medicni perspektivi

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.

Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.