title: Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis.
abstract: BACKGROUND
  Immunosuppressive and cytotoxic agents have been used as both an alternative to oral corticosteroids, and as a means of maintaining a low dose of steroids in the treatment of pulmonary sarcoidosis.
  
  
  OBJECTIVE
  To determine the efficacy of immunosuppressive and cytotoxic agents in the treatment of pulmonary sarcoidosis.
  
  
  METHODS
  The Cochrane Airways Group trials register was searched for possible randomised trials. Bibliographies were searched for other potentially relevant trials. Searches were current as of February 2001.
  
  
  METHODS
  Randomised controlled trials comparing an immunosuppressive or cytotoxic therapy with a control in patients with pulmonary sarcoidosis were included in the review.
  
  
  METHODS
  Two reviewers independently extracted data for entry in to the Review Manager statistical package (MetaView 4.1). Pharmaceutical companies and study investigators were contacted for unpublished trials.
  
  
  RESULTS
  Four studies were included in the review. Trials comparing methotrexate, chloroquine and cyclosporin A were identified. No data could be combined for a meta-analysis. Data on lung function, chest x-ray scores and dyspnoea were largely inconclusive. Adverse effects were associated with methotrexate, cyclosporin A and chloroquine. In one small study, methotrexate was associated with a steroid sparing effect after 12 months of therapy, but no difference was observed at 6 months.
  
  
  CONCLUSIONS
  The current body of evidence supporting the use of immunosuppressive agents and cytotoxic therapies is limited. Side-effects associated with some of the therapies were severe.
authors.affiliation: Respiratory Medicine, Kingston Hospital NHS Trust, Galsworthy Rd, Kingston Upon Thames, Surrey, UK, KT2 7QB.
authors.forename: S
authors.initials: S
authors.lastname: Paramothayan
authors.forename: T
authors.initials: T
authors.lastname: Lasserson
authors.forename: E H
authors.initials: EH
authors.lastname: Walters
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D017565:Sarcoidosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D002738:Chloroquine; D008727:Methotrexate