Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen

In a few patients with chronic sarcoidosis, prolonged, unacceptably high do ses of corticosteroids are required to achieve symptomatic relief, In these cases, a corticosteroid-sparing drug might be administered to allow long-t erm treatment without the adverse effects of corticosteroids. This study ex amines azathioprine as a prednisolone-sparing treatment. In an open study, the course of 11 patients with chronic sarcoidosis was an alysed. In an induction phase, 2 mg azathioprine.kg body weight (BW)(-1).da y(-1) in combination with 0.6-0.8 mg prednisolone.kg BW-1.day(-1) were admi nistered with prednisolone being reduced to 0.1 mg.kg BW-1.day(-1) within 2 -3 months, This was followed by a 21-22-month maintenance phase with 2 mg a zathioprine.kg BW-1.day(-1) and 0.1 mg prednisolone.kg BW-1.day(-1). Clinic al parameters and immunological findings of bronchoalveolar lavage (BAL) we re analysed. All patients had significant symptomatic relief and improvements or resolut ions of physiological, serological and radiographic findings without suffer ing from serious adverse effects. Nine of 11 patients completed therapy aft er 19-26 months, and 2/11 patients terminated therapy after 8 and 12 months , respectively. Eight patients had remissions lasting 4-73 months. Three re lapses occurred after 8, 18, and 22 months, During the induction phase, BAL cell composition changed and their activity in terms of cytokine release w as suppressed. This preliminary study suggests that azathioprine may be effective as a cor ticosteroid-sparing agent in long-term therapy of sarcoidosis, but a much l arger study is necessary to give the definitive answer.