Source: Annual Congress 2006 - Sarcoidosis

Abstract

Tumour necrosis factor alpha (TNF) has been identified as an important endogenous mediator of granuloma formation in sarcoidosis. Therefore, drugs interfering with the formation of TNF may have a beneficial effect in this disease. Pentoxifylline (PF) exerts additional immunomodulatory properties like inhibition of endogenous TNF formation, synergistically to the effects of steroids. Thus, we investigated a combination of steroid with PF in the treatment of 20 patients (f – 10, m – 10) with chronic active sarcoidosis after conventional high-dose steroid monotherapy had failed. Combination of prednisone (0,8 mg/kg BW orally/day) with PF (25mg/kg BW orally/day) resulted in an immediate complete decrease of disease activity as monitored by a score system consisting of chest X-ray, pulmonary function test, and immunological parameters. After tapering prednisone doses to 7,5 mg/kg while continuing PF treatment sarcoidosis remained inactive in all patients. During the follow-up period (ranging from 18 up to 36 month) no relapse occurred in any of the patients. In 5 patient prednisone treatment was discontinued after 9 month without any relapse of the disease, whereas discontinuation of PF treatment 3 months later resulted in an immediate increase in disease activity. After resuming PF treatment remission continues until now. We conclude that combination of steroid with PF may be beneficial in patients with active sarcoidosis who do not respond to high-dose steroid therapy. Furthermore, PF may exert a steroid-sparing effect in the treatment of active sarcoidosis, and, thus, reduce severe side of a long-lasting steroid therapy.

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O. S. Tolokh, A. Y. Ladnyy (Lviv, Ukraine). The efficacy of steroid with pentoxifylline in steroid resistant sarcoidosis. Eur Respir J 2006; 28: Suppl. 50, 3133

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