Efficacy of azathioprine as second-line treatment in pulmonary sarcoidosis

Background and aim of work: Immunosuppressives such as azathioprine are occ asionally used in sarcoidosis where corticosteroids cannot be used because of poor response, contraindications or unacceptable side effects. The aim o f this study was to assess the efficacy and safety of azathioprine in the t reatment of pulmonary sarcoidosis. Methods: A retrospective study was perfo rmed on patients in the Respiratory Clinic of the university teaching hospi tal on all biopsy-proven sarcoid treated with azathioprine between 1969 and 1993 (n = 10). All had previously shown only partial (n = 6) or no (n = 4) response to high dose oral corticosteroids, Azathioprine in a dose of 100- 150 mg was administered daily, while continuing a small dose of oral cortic osteroid. Patients underwent regular clinical evaluation, pulmonary functio n testing and chest radiography. Results: In one patient the course was too brief to evaluate (26 days). Two patients had significant and sustained im provement in lung function (vital capacity increasing from 72% to 89% and f rom 49% to 79% of predicted respectively, and transfer factor from 78% to 1 14% and from 27% to 49% of predicted respectively), and chest radiograph cl eared. Two patients had short-lived improvement and steroid-sparing effect. In the remainder (n = 5), no benefit was observed. No patient responded to azathioprine who had failed to respond to high dose corticosteroids, There was no significant toxicity. Conclusions: Azathioprine may provide a safe alternative to corticosteroids when a steroid-sparing effect is required, b ut it is unlikely to be effective in patients who fail to respond to high d ose corticosteroids and/or have radiographic evidence of significant fibros is.