LOW-DOSE METHOTREXATE THERAPY FOR CHILDHOOD SARCOIDOSIS

Objective: To evaluate the effectiveness of low oral doses of methotre xate as a steroid-sparing agent in children with sarcoidosis. Study de sign: An open-label, noncontrolled trial. Methotrexate was administere d orally at a single weekly dose of 10 to 15 mg/m(2). Duration of ther apy 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 th e end of the follow-up period, respectively. Other clinical and labora tory parameters improved significantly after methotrexate therapy was started. There was significant clinical improvement, as confirmed by t he 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, respectiv ely. 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-convertin g enzyme activity dropped significantly. No adverse side effects were noted with methotrexate therapy. Conclusion: Our study demonstrated th at low-dose oral methotrexate therapy was effective and safe and had s teroid-sparing properties in seven children with sarcoidosis.