Abstract

Many patients with pulmonary sarcoidosis experience reduced quality of life. Although oral corticosteroids are the most common agents used in sarcoidosis, very little is known on the effects on quality of life. We evaluated the efficacy of low dose oral dexamethasone in newly diagnosed patients without an indication for high dose immunosuppressive therapy.

In this double-blind, placebo-controlled trial, patients were randomised to once-daily dexamethasone 1 mg (6.5 mg prednisone equivalent) or placebo for 6 months. The primary study parameter was the subscale physical functioning of the 36-item Short Form health survey (SF-36). Secondary parameters included other patient reported outcome measures, disease activity markers and plasma cytokine profiles.

A total of 16 patients were randomised to dexamethasone (n=7) and placebo (n=9). During follow-up no significant difference for physical functioning was measured (p=0.184). Dexamethasone treated patients showed a decrease in fatigue score (Checklist Individual Strength) from 106 (baseline) to 88 (3 months; p=0.032); 86 (6 months; p=0.048); 90 (12 months; p=0.025). Placebo treated patients showed no change: 96 (baseline) to 105 (3 months; p=0.163); 91 (6 months; p=0.483); 95 (12 months; p=0.904). During treatment with dexamethasone significant improvements in the SF-36 subscales vitality and pain, and a reduction in serum cortisol, angiotensin-converting enzyme and soluble interleukin 2 receptor levels were measured.

Low-dose dexamethasone results in a reduction of the inflammatory profile and has the potential to improve quality of life parameters and fatigue.