Early Treatment of Stage II Sarcoidosis Improves 5-Year Pulmonary Function

Pietinalho, Anne; Tukiainen, P; Haahtela, Tari; Persson, Tore; Selroos, Olof

doi:10.1378/chest.121.1.24

Cited by 126 publications

(64 citation statements)

References 14 publications

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“…For patients with no symptoms and no evidence of parenchymal lung disease, there was no difference in treatment with corticosteroids versus placebo [16]. For patients with parenchymal lung disease on chest radiography but no symptoms, treatment for 18 months with glucocorticoids was better than placebo 5 years after initiation of therapy [14,87]. This improvement was seen for the FVC [14,87], changes in the F (fibrosis) score [14], and less dyspnoea [14].…”

Section: Individual Drugs For Pulmonary Sarcoidosismentioning

confidence: 99%

“…For patients with parenchymal lung disease on chest radiography but no symptoms, treatment for 18 months with glucocorticoids was better than placebo 5 years after initiation of therapy [14,87]. This improvement was seen for the FVC [14,87], changes in the F (fibrosis) score [14], and less dyspnoea [14]. Asymptomatic patients treated with glucocorticoids for 18 months were less likely to require glucocorticoids during the 32 month follow-up [87].…”

Section: Individual Drugs For Pulmonary Sarcoidosismentioning

confidence: 99%

“…This improvement was seen for the FVC [14,87], changes in the F (fibrosis) score [14], and less dyspnoea [14]. Asymptomatic patients treated with glucocorticoids for 18 months were less likely to require glucocorticoids during the 32 month follow-up [87]. Some have argued that the changes with corticosteroid treatment did not justify the toxicity encountered with 18 months of corticosteroids.…”

Section: Individual Drugs For Pulmonary Sarcoidosismentioning

confidence: 99%

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Established and experimental medical therapy of pulmonary sarcoidosis

et al. 2013

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The treatment options for pulmonary sarcoidosis have increased over the past 10 years. As new treatments have been introduced, the best way to assess and compare treatments remains unknown. The goal of this review is to discuss the standard treatments for pulmonary sarcoidosis, including glucocorticoids, and cytotoxic agents, such as methotrexate, azathioprine and leflunomide, and compare them to the newer biological agents, such as infliximab and adalimumab. We also discuss some novel treatments which are currently being evaluated. To compare these different regimens, we look at the measures used to assess response. These include pulmonary function, chest imaging, steroid sparing potential and, more recently, improvements in quality of life measures. While there is, as yet, no standard assessment for response, there is a growing consensus that response to treatment may include improvement of one or more of the following: forced vital capacity, chest imaging and steroid sparing. Several drugs used for pulmonary sarcoidosis have demonstrated improvement in one or more of these measures.

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Section: Individual Drugs For Pulmonary Sarcoidosismentioning

confidence: 99%

Section: Individual Drugs For Pulmonary Sarcoidosismentioning

confidence: 99%

Section: Individual Drugs For Pulmonary Sarcoidosismentioning

confidence: 99%

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Established and experimental medical therapy of pulmonary sarcoidosis

et al. 2013

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“…However, a recent systematic Cochrane review (updated on February 17, 2005) identified only six randomised controlled trials on oral corticosteroid therapy for pulmonary sarcoidosis in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL); a summary of each is given in table 1 [27,[30][31][32][33][34][35][36]. From these trials, it can be concluded that oral corticosteroids significantly improve symptoms, biochemical markers, lung function and chest radiography results over 3-24 months of treatment.…”

Section: Pulmonary Diseasementioning

confidence: 99%

Corticosteroid treatment in sarcoidosis

Grutters

Bosch²

2006

Eur Respir J

168

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At present there is no curative treatment for sarcoidosis. Immunosuppressive and/or immunomodulatory drugs can, however, be used for controlling the disease.Corticosteroids remain the mainstay of therapy. They function by suppressing the proinflammatory cytokines and chemokines that are involved in cell-mediated immune responses and granuloma formation. Only in a select group of patients is it justifiable to use these drugs, after careful evaluation of the pros and cons. Importantly, disease severity, e.g. threatened organ functions, and not disease activity itself should be the deciding factor in this process.In the case of parenchymal involvement, there is substantial evidence that corticosteroids can improve respiratory symptoms and chest radiography and lung function parameters over 6-24 months. Other generally acknowledged (empirical) criteria for systemic treatment include neurological, cardiac and sight-threatening ocular involvement and hypercalcaemia. Remarkably, despite .50 yrs of use, there is no proof of long-term (survival) benefit from corticosteroid treatment. In addition, there are still no data regarding the optimal dose and duration of corticosteroid or other immunosuppressive therapy.One of the weightiest questions remaining is whether or not these drugs can prevent scarring in patients with a fibrogenic phenotype. As new agents, including infliximab and thalidomide, enter the stage and new diagnostic tools are now available, there is clearly a momentum to design multicentric randomised controlled trials with long enough follow-up (.5 yrs) to answer this pivotal question.

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“…Despite decades of clinical practice, very few randomized clinical trials have substantiated a benefit [2,3]; nonetheless, steroids are still considered the first-line therapy for sarcoidosis by most experts. Given the undesirable side effects of glucocorticoids [4,5], and the existence of refractory cases [6], there is widespread recognition that other therapeutic options should be developed or adapted in sarcoidosis.…”

Section: Introductionmentioning

confidence: 99%