Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis

Cochrane Database Syst Rev. 2006 Jul 19;2006(3):CD003536. doi: 10.1002/14651858.CD003536.pub2.


Background: 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.

Objectives: To determine the efficacy of immunosuppressive and cytotoxic agents in the treatment of pulmonary sarcoidosis.

Search strategy: 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.

Selection criteria: Randomised controlled trials comparing an immunosuppressive or cytotoxic therapy with a control in patients with pulmonary sarcoidosis were included in the review.

Data collection and analysis: Two reviewers independently extracted data for entry in to the RevMan 4.2. Pharmaceutical companies and study investigators were contacted for unpublished trials.

Main results: 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.

Authors' conclusions: 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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Chloroquine / therapeutic use
  • Cyclosporine / therapeutic use
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Methotrexate / therapeutic use
  • Pentoxifylline / therapeutic use
  • Prednisone / therapeutic use
  • Randomized Controlled Trials as Topic
  • Sarcoidosis, Pulmonary / drug therapy*


  • Antineoplastic Agents
  • Immunosuppressive Agents
  • Cyclosporine
  • Chloroquine
  • Pentoxifylline
  • Prednisone
  • Methotrexate