• S Paramothayan, T J Lasserson, and E H Walters.
• Cochrane Db Syst Rev. 2006 Jul 19; 2006 (3): CD003536CD003536.

BackgroundImmunosuppressive 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.ObjectivesTo determine the efficacy of immunosuppressive and cytotoxic agents in the treatment of pulmonary sarcoidosis.Search StrategyCENTRAL, 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 CriteriaRandomised controlled trials comparing an immunosuppressive or cytotoxic therapy with a control in patients with pulmonary sarcoidosis were included in the review.Data Collection And AnalysisTwo reviewers independently extracted data for entry in to the RevMan 4.2. Pharmaceutical companies and study investigators were contacted for unpublished trials.Main ResultsFive studies were included in the review.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' ConclusionsThe 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.

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