Prednisone is really useful because the first-line therapy for pulmonary sarcoidosis, however this steroid causes numerous undesirable unwanted effects. Now new analysis, revealed on the ATS 2025 Worldwide Convention and within the American Journal of Respiratory and Vital Care Drugs, finds that methotrexate supplies a comparable different.
Researchers discovered that methotrexate was as efficient in controlling the illness, with probably fewer unwanted effects than prednisone. The randomized, managed trial, performed 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 outcomes of this trial present that methotrexate might be provided as a substitute for prednisone for sufferers 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 scientific course and prognosis. Whereas some sufferers expertise spontaneous remission, others require immunosuppressive therapy to take care of organ operate and enhance high quality of life.
Although worldwide pointers suggest prednisone for use as standard-of-care for pulmonary sarcoidosis, these suggestions haven’t been based mostly on randomized scientific trials.
Prednisone is usually accompanied by unwanted 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 threat of persistent problems.
For the PREDMETH trial, researchers in contrast 69 sufferers who obtained prednisone for pulmonary sarcoidosis with 68 who obtained methotrexate. They discovered that methotrexate was non-inferior to prednisone after 24 weeks of therapy however had a slower onset of efficacy.
Though the entire variety of unwanted effects have been related, the methotrexate group had fewer ongoing unwanted effects at 24 weeks. The unwanted effects themselves have been additionally completely different, with weight acquire, insomnia, and elevated urge for food commonest within the prednisone group, and nausea, fatigue, and liver operate abnormalities frequent within the methotrexate group.
“Outcomes have been consistent with what we hypothesized,” stated final writer Marlies Wijsenbeek, MD, a pulmonologist on the Erasmus Medical Heart.
“It was, nonetheless, shocking to see that some symptom scores had already improved after 4 weeks of therapy within the methotrexate group. She stated the findings will assist docs and sufferers make extra personalised therapy plans, noting that therapy selections must be based mostly on particular person sufferers’ preferences and desires.
“Some sufferers prioritize quick enchancment of signs and are much less afraid of unwanted effects, whereas different sufferers might wish to wait longer for therapy results if this implies they will keep away from steroid toxicity,” Dr. Kahlmann famous.
Trying forward, researchers plan to develop a decision-aid instrument to assist docs and sufferers navigate therapy selections. In addition they plan follow-up research, together with analyzing blood samples from research members to establish mobile biomarkers to foretell therapy response.
Extra data:
V. Kahlmann et al, Methotrexate Versus Prednisone as First-line Therapy for Pulmonary Sarcoidosis: The PREDMETH Trial, American Journal of Respiratory and Vital Care Drugs (2025). DOI: 10.1164/ajrccm.2025.211.Abstracts.A1007
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Methotrexate as efficient as prednisone in pulmonary sarcoidosis, analysis finds (2025, Might 18)
retrieved 19 Might 2025
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