Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis

Abstract

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. To determine the efficacy of immunosuppressive and cytotoxic agents in the treatment of pulmonary sarcoidosis. CENTRAL, MEDLINE, EMBASE and CINAHL were searched for possible randomised trials and bibliographies were checked for other potentially relevant trials. Searches were current as of April 2006. Randomised controlled trials comparing an immunosuppressive or cytotoxic therapy with a control in patients with pulmonary sarcoidosis were included in the review. Two reviewers independently assessed studies for inclusion and extracted data for entry in to the RevMan 4.2. Pharmaceutical companies and study investigators were contacted for unpublished trials. Five studies were included in the review. Trials comparing methotrexate, chloroquine, cyclosporin A and pentoxifylline 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, chloroquine and pentoxifylline. In two small studies methotrexate and pentoxifylline were associated with a steroid sparing effect. In the methotrexate study this was apparent after 12 months of therapy, but no difference was observed at 6 months. 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. 使用免疫抑制劑及細胞毒性治療於肺纇肉芽病 免疫抑制劑及細胞毒性藥物已被用作口服皮質類固醇的替代劑，以及作為治療肺類肉芽病維持類固醇低劑量的方法。 確認免疫抑制劑及細胞毒性藥物在治療肺類肉芽病的效用。 從CENTRAL，MEDLINE，EMBASE及CINAHL搜尋可能引用的隨機試驗，並從其參考文獻中找出其他可能相關的試驗。目前搜尋至2006年4月。 本回顧納入比較使用免疫抑制或細胞毒性治療或安慰劑來治療肺類肉芽病患者的隨機對照試驗。 兩位審查者獨立地評估研究能否納入以及摘錄數據來輸入RevMan4.2。接觸藥品製造商及研究人員探查有關未被刊載的試驗。 本回顧共納入五項研究，試驗分別比較methotrexate，chloroquine，cyclosporin A 及pentoxifylline。沒有數據能供作綜合分析。有關肺功能、肺部X光片評分及呼吸困難等數據大多無法作出結論。使用methotrexate，cyclosporin A，chloroquine及pentoxifylline均伴隨不良效應。有兩項小規模的研究顯示methotrexate及pentoxifylline具有類固醇減量效應，在使用methotrexate的研究中，治療達12個月以後呈現此一效應，但在6個月時則未見到差異。 支持使用免疫抑制劑或細胞毒性治療的現有證據很有限。其中有些治療則伴隨嚴重的副作用。 本摘要由中國醫藥大學附設醫院陳祖裕翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 類肉芽病可影響身體大多數的器官，包括肺、心臟、腦、骨骼、肝臟及皮膚，對於重症或使用類固醇治療無效的患者常會使用強效藥劑來壓抑免疫系統企圖控制病情。然而，這些藥物有嚴重的副作用。現時沒有證據顯示這些藥物提供的效益重於他們的副作用。