Low-dose methotrexate therapy for childhood sarcoidosis.
OBJECTIVE
To evaluate the effectiveness of low oral doses of methotrexate as a steroid-sparing agent in children with sarcoidosis.


METHODS
An open-label, noncontrolled trial. Methotrexate was administered orally at a single weekly dose of 10 to 15 mg/m2. Duration of therapy was open ended, but patients received treatment for a minimum of 6 months to be considered as having completed the study.


RESULTS
Seven children with biopsy-proven sarcoidosis completed the study. The mean dose of prednisone was successfully tapered from 49 mg/day (1.3 mg/kg) to 18 mg/day (0.5 mg/kg) after 3 months of methotrexate therapy and to 9.9 (0.2 mg/kg) and 7.3 mg/day (0.1 mg/kg) after 6 months and at the end of the follow-up period, respectively. Other clinical and laboratory parameters improved significantly after methotrexate therapy was started. There was significant clinical improvement, as confirmed by the reduction of the clinical severity score from 8 +/- 1.1 to 0.8 +/- 0.5 point after 3 months of methotrexate therapy, and to 0.7 and 0.5 +/- 0.3 point after 6 months and at the end of the follow-up, respectively. Laboratory measurements revealed marked improvement, as reflected by a significant reduction in the erythrocyte sedimentation rate and an increase of hemoglobin values. The mean serum angiotensin-converting enzyme activity dropped significantly. No adverse side effects were noted with methotrexate therapy.


CONCLUSIONS
Our study demonstrated that low-dose oral methotrexate therapy was effective and safe and had steroid-sparing properties in seven children with sarcoidosis.
Gedalia
A
A
Division of Pediatric Rheumatology, Children's Hospital, New Orleans, Louisiana State University Medical Center 70112-2822, USA.
Molina
J F
JF
Ellis
G S
GS
Galen
W
W
Moore
C
C
Espinoza
L R
LR
D000284:Administration, Oral; D002648:Child; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000145:classification / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D005938:Glucocorticoids; D011241:Prednisone; D008727:Methotrexate