title: Antifungal medication is efficient in the treatment of sarcoidosis.
abstract: OBJECTIVE
  Fungi have been suspected of contributing to the pathogenesis of sarcoidosis. A previous intervention study demonstrated an improvement in the clinical condition in 15 out of 18 patients with a long-term history of sarcoidosis when antifungal medication was added to corticosteroids. The present study was performed to compare the effects of antifungal treatment with corticosteroid treatment in sarcoidosis.
  
  
  METHODS
  Patients with newly diagnosed sarcoidosis were recruited. Corticosteroids were given to 39 subjects, corticosteroid + antifungal to 31, and antifungal only to 22 subjects. The effects of the treatments were evaluated at 6 months. X-ray scores were measured before and after treatment together with pulmonary diffusion capacity and two markers of sarcoidosis activity, that is, angiotensin-converting enzyme in serum (sACE) and chitotriosidase (CTO).
  
  
  RESULTS
  X-ray scores as well as sACE and CTO decreased significantly in all groups. The X-ray score decreased slightly more among subjects in the groups that received antifungal medication compared with corticosteroids only (p < 0.001).
  
  
  CONCLUSIONS
  The results suggest that antifungal treatment is as efficient as corticosteroid treatment against the granulomatous and inflammatory manifestations of sarcoidosis. This is probably because this treatment is directed towards the causative agent. Additional studies are required to define the phenotype, where the antifungal treatment was not efficient (4/22) and to perform long-term follow up to determine the risk of recurrence.
authors: Clinic of Pulmonary Disease and Allergy, University Medical Centre, Zaloska 7, 1000 Ljubljana, Slovenia. marjeta.tercelj@kclj.si
authors: Marjeta
authors: M
authors: Tercelj
authors: Barbara
authors: B
authors: Salobir
authors: Mirjana
authors: M
authors: Zupancic
authors: Ragnar
authors: R
authors: Rylander
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006596:Hexosaminidases / Q000097:blood; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D012507:Sarcoidosis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D005938:Glucocorticoids; D017964:Itraconazole; D006596:Hexosaminidases; C086400:chitotriosidase; D007703:Peptidyl-Dipeptidase A; D008775:Methylprednisolone