Methotrexate vs Azathioprine in Second-line Therapy of Sarcoidosis

Vorselaars, Adriane D.M.; Wuyts, Wim; Vorselaars, Veronique M.M.; Zanen, Pieter; Deneer, Vera H.M.; Veltkamp, Marcel; Thomeer, Michiel; Moorsel, Coline H.M. van; Grutters, Jan C.

doi:10.1378/chest.12-1728

Cited by 237 publications

(170 citation statements)

References 17 publications

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“…Azathioprine with a slowly increased dose to approximately 2 mg/kg b.w. (200 mg/d at the maximum) can be used instead of MTX, with similar efficacy and steroid-sparing capacity but more infections as side effects (119). Before starting azathioprine, activity of the enzyme thiopurinmethyltransferase (TPMT) should be determined to detect patients with a particular sensitivity to myelosuppressive effects of azathioprine.…”

Section: Treatmentmentioning

confidence: 99%

Challenges in the diagnosis and treatment of neurosarcoidosis

et al. 2015

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The diagnosis and treatment of neurosarcoidosis can be very challenging for several reasons. It affects clinically 5%-10% of sarcoidosis patients, but can be found in up to 25% of autopsies. These data reveal that a high percentage of asymptomatic or misdiagnosed cases can be missed at an initial diagnostic approach. Clinical and imaging findings are often non-specific since they can be found in a large number of neurological disorders. Histopathology can also be confounding if not performed by an expert pathologist and not placed in an appropriate clinical context. In this review, we discuss clinical features, laboratory findings, imaging, and histology of neurosarcoidosis, and we report current evidence regarding drug therapy. We conclude that a correct diagnostic approach should include a multidisciplinary evaluation involving clinicians, radiologists, and pathologists and that future studies should evaluate the genetic signature of neurosarcoidosis as they could be helpful in the assessment of this uncommon disease. With head-to-head comparisons of medical treatment for neurosarcoidosis still lacking due to the rarity of the disease and an increasing number of immunomodulating therapies at hand, novel therapeutic approaches are to be expected within the next few years. Key messages Neurosarcoidosis is a rare disorder that affects clinically 5%-10% of sarcoidosis patients, but can be found in up to 25% of autopsies, revealing that a high percentage of asymptomatic or misdiagnosed cases can be missed at an initial diagnostic approach. A multidisciplinary evaluation is useful to achieve a correct diagnosis because clinical and imaging findings are often non-specific. Corticosteroids are the first-line treatment for neurosarcoidosis, followed by steroid-sparing immune-modulating agents if prednisone therapy is insufficient. Dear Author, Please check these proofs carefully. It is the responsibility of the corresponding author to check against the original manuscript and approve or amend these proofs. A second proof is not normally provided. Informa Healthcare cannot be held responsible for uncorrected errors, even if introduced during the composition process. The journal reserves the right to charge for excessive author alterations, or for changes requested after the proofing stage has concluded.The following queries have arisen during the editing of your manuscript and are marked in the margins of the proofs. Unless advised otherwise, submit all corrections using the CATS online correction form. Once you have added all your corrections, please ensure you press the ''Submit All Corrections'' button.Please review the table of contributors below and confirm that the first and last names are structured correctly and that the authors are listed in the correct order of contribution. The diagnosis and treatment of neurosarcoidosis can be very challenging for several reasons. It affects clinically 5%-10% of sarcoidosis patients, but can be found in up to 25% of autopsies. These data reveal that a high percenta...

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Section: Treatmentmentioning

confidence: 99%

Challenges in the diagnosis and treatment of neurosarcoidosis

et al. 2015

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“…To investigate the relation between serum sIL-2R levels and renal function, we performed a retrospective analysis in a cohort that was previously described by VORSELAARS et al [9]. This cohort consists of patients treated with methotrexate at St Antonius Hospital, Nieuwegein, which is a tertiary referral centre for interstitial lung disease in The Netherlands.…”

Section: Discrepant Elevation Of Sil-2r Levels In Sarcoidosis Patientmentioning

confidence: 99%

Discrepant elevation of sIL-2R levels in sarcoidosis patients with renal insufficiency

et al. 2015

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“…Recently, azathioprine was directly compared to methotrexate as a steroid sparing second line of defense alternative. Results were indicative of similar increases in pulmonary function for both drugs; however, more infections requiring antibiotics intervention were seen in the azathioprine group [113].…”

Section: Disease Modifying Anti-rheumatic Drugsmentioning

confidence: 77%

Sarcoidosis: Unknown Etiology and Genetic Predisposition Provides Therapeutic Challenges

Rotsinger

Drake²

2014

J Pulm Respir Med

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Sarcoidosis is an idiopathic multisystem disorder characterized by noncaseating epithelioid granulomas predominately affecting lungs and lymph nodes, but with potential to affect any organ system. Sarcoidosis shares similarities in development to other infectious granulomatous diseases, such as berylliosis and tuberculosis; however, its elusive etiology and non-distinctive histology have provided many diagnostic challenges. Evidence of a transferrable antigen combined with a high incidence rate in the lungs has focused efforts primarily on antigens with airborne transmissibility. While Mycobacterium tuberculosis and Propionibacterium acnes have provided strong associations to implicate each as a contributor to sarcoidosis pathogenesis, detection challenges remain and consensus of a definitive antigen is lacking.

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Methotrexate vs Azathioprine in Second-line Therapy of Sarcoidosis

Cited by 237 publications

References 17 publications

Challenges in the diagnosis and treatment of neurosarcoidosis

Challenges in the diagnosis and treatment of neurosarcoidosis

Discrepant elevation of sIL-2R levels in sarcoidosis patients with renal insufficiency

Sarcoidosis: Unknown Etiology and Genetic Predisposition Provides Therapeutic Challenges

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