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Prednisone is beneficial because the first-line therapy for pulmonary sarcoidosis, however this steroid causes quite a few undesirable uncomfortable side effects. Now new analysis, printed on the ATS 2025 Worldwide Convention and within the American Journal of Respiratory and Crucial Care Medication, finds that methotrexate supplies a comparable various.
Researchers discovered that methotrexate was as efficient in controlling the illness, with probably fewer uncomfortable side effects than prednisone. The randomized, managed trial, carried out as a part of a collaboration amongst 17 hospitals within the Netherlands, supplies the primary high-quality information evaluating the 2 therapies in sufferers with pulmonary sarcoidosis.
“The results of this trial show that methotrexate can be offered as an alternative for prednisone for patients with pulmonary sarcoidosis,” stated first writer Vivienne Kahlmann, MD, a pulmonologist in coaching at Erasmus Medical Heart in Rotterdam, Netherlands.
Sarcoidosis is a fancy immunological illness with a extremely variable medical course and prognosis. Whereas some sufferers expertise spontaneous remission, others require immunosuppressive therapy to keep up organ operate and enhance high quality of life.
Regardless that worldwide pointers advocate prednisone for use as standard-of-care for pulmonary sarcoidosis, these suggestions haven’t been primarily based on randomized medical trials.
Prednisone is usually accompanied by uncomfortable side effects like weight acquire, sleep disturbance, and psychological signs, which may negatively have an effect on sufferers’ high quality of life. As well as, long-term use is related to a excessive danger of persistent problems.
For the PREDMETH trial, researchers in contrast 69 sufferers who acquired prednisone for pulmonary sarcoidosis with 68 who acquired methotrexate. They discovered that methotrexate was non-inferior to prednisone after 24 weeks of therapy however had a slower onset of efficacy.
Though the whole variety of uncomfortable side effects have been related, the methotrexate group had fewer ongoing uncomfortable side effects at 24 weeks. The uncomfortable side effects themselves have been additionally totally different, with weight acquire, insomnia, and elevated urge for food most typical within the prednisone group, and nausea, fatigue, and liver operate abnormalities frequent within the methotrexate group.
“Results were in line with what we hypothesized,” stated final writer Marlies Wijsenbeek, MD, a pulmonologist on the Erasmus Medical Heart.
“It was, nevertheless, stunning to see that some symptom scores had already improved after 4 weeks of therapy within the methotrexate group. She stated the findings will assist medical doctors and sufferers make extra personalised therapy plans, noting that therapy choices ought to be primarily based on particular person sufferers’ preferences and wishes.
“Some patients prioritize fast improvement of symptoms and are less afraid of side effects, while other patients may want to wait longer for treatment effects if this means they can avoid steroid toxicity,” Dr. Kahlmann famous.
Wanting forward, researchers plan to develop a decision-aid software to assist medical doctors and sufferers navigate therapy decisions. Additionally they plan follow-up research, together with analyzing blood samples from research members to establish mobile biomarkers to foretell therapy response.
Extra info:
V. Kahlmann et al, Methotrexate Versus Prednisone as First-line Therapy for Pulmonary Sarcoidosis: The PREDMETH Trial, American Journal of Respiratory and Crucial Care Medication (2025). DOI: 10.1164/ajrccm.2025.211.Abstracts.A1007
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Methotrexate as efficient as prednisone in pulmonary sarcoidosis, analysis finds (2025, Could 18)
retrieved 18 Could 2025
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