Randomized trial of prolonged chloroquine therapy in advanced pulmonary sarcoidosis

Sarcoidosis may cause severe ventilatory impairment requiring corticosteroi d treatment. Chloroquine (CQ) can be an effective treatment for lung sarcoi dosis with few side effects, but has not been accepted as standard therapy. We investigated the benefits of prolonged CQ therapy in 23 symptomatic pat ients with biopsy-proven pulmonary sarcoidosis (duration, greater than or e qual to 2 yr). Patients were initially treated for 6 mo with CQ, 750 mg/d, tapering every 2 mo to 250 mg/d. Eighteen patients were then randomized to either a Maintenance group (Ca 250 mg/d) or to an Observation group (no CQ) . After the initial treatment, significant improvement was observed in symp toms, pulmonary function, angiotensin-converting enzyme, and lung gallium s can. Patients randomized to the Maintenance group showed a slower decline i n pulmonary function (FEV1, 51.4 +/- 28.2 ml/yr [Maintenance] versus 196.3 +/- 33.4 ml/yr [Observation], p < 0.02) and had fewer relapses: 2 of 10 pat ients in the Maintenance group at 29.5 +/- 4.9 mo versus 6 of 8 patients in the Observation group at 15.5 +/- 2.9 mo. Adverse effects were seen mainly during high-CQ dosage. We conclude that CQ should be an important consider ation for the treatment and maintenance of chronic pulmonary sarcoidosis.