Low-dose methotrexate therapy for childhood sarcoidosis,☆☆

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Abstract

Objective: To evaluate the effectiveness of low oral doses of methotrexate as a steroid-sparing agent in children with sarcoidosis.

Study design: An open-label, noncontrolled trial. Methotrexate was administered orally at a single weekly dose of 10 to 15 mg/m 2 . Duration of therapy was open ended, but patients received treatment for a minimum of 6 months to be considered as having completed the study.

Results: Seven children with biopsy-proven sarcoidosis completed the study. The mean dose of prednisone was successfully tapered from 49 mg/day (1.3 mg/kg) to 18 mg/day (0.5 mg/kg) after 3 months of methotrexate therapy and to 9.9 (0.2 mg/kg) and 7.3 mg/day (0.1 mg/kg) after 6 months and at the end of the follow-up period, respectively. Other clinical and laboratory parameters improved significantly after methotrexate therapy was started. There was significant clinical improvement, as confirmed by the reduction of the clinical severity score from 8 ± 1.1 to 0.8 ± 0.5 point after 3 months of methotrexate therapy, and to 0.7 and 0.5 ± 0.3 point after 6 months and at the end of the follow-up, respectively. Laboratory measurements revealed marked improvement, as reflected by a significant reduction in the erythrocyte sedimentation rate and an increase of hemoglobin values. The mean serum angiotensin-converting enzyme activity dropped significantly. No adverse side effects were noted with methotrexate therapy.

Conclusion: Our study demonstrated that low-dose oral methotrexate therapy was effective and safe and had steroid-sparing properties in seven children with sarcoidosis.

1997;130:25-9

Section snippets

METHODS

This study was designed as an open-label, noncontrolled trial. The duration of therapy was open ended, but patients received treatment for a minimum of 6 months to be considered as having completed the study. The aim of our study was to evaluate the effectiveness of low-dose methotrexate therapy as a steroid-sparing agent in children with sarcoidosis.

RESULTS

Seven patients were enrolled in the study; all had histologically proven sarcoidosis. Table II lists the demographic and clinical characteristics of the seven patients studied.

. Demographic and clinical characteristics of seven children with sarcoidosis at diagnosis

CharacteristicChildren (No.)
Demographic
Sex (F/M)4/3
Race (B/W)6/1
Mean age at diagnosis (yr)11
Duration of illness (mo)21
Duration of methotrexate therapy (mo)13
Clinical signs present
Iritis6/7
Fever5/7
Weight loss5/7
Arthritis4/7
Lung

DISCUSSION

The current therapy of choice for childhood sarcoidosis with multisystem involvement is the use of corticosteroids. 1 These patients may follow a course of chronic relapse, and because they are usually steroid dependent, they need long-term treatment with relatively high dosages to achieve satisfactory responses. In such cases, serious complications from long-term corticosteroid therapy may be problematic. Moreover, a subset of patients with persistently active or progressive sarcoidosis may be

References (25)

  • S. Hetherington

    Sarcoidosis in young children

    Arch Pediatr Adolesc Med [Am J Dis Child]

    (1982)
  • OP. Sharma

    Pulmonary sarcoidosis and corticosteroids

    Am Rev Respir Dis

    (1993)
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    Reprint requests: Abraham Gedalia, MD, Department of Pediatrics, Louisiana State University Medical Center, 1542 Tulane Ave., New Orleans, LA 70112-2822.

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