Reconsidering First-Line Treatment for Patients with Pulmonary Sarcoidosis

For longer than 50 years, our first-line treatment for patients with pulmonary sarcoidosis has been prednisone; however, patients struggle with the medication's many side effects. Would methotrexate, a well-established second-line therapy that is better tolerated, be as effective?

In this multicenter trial, investigators randomized 138 patients with pulmonary sarcoidosis who had not been treated previously to receive either prednisone or methotrexate. Oral prednisone was initiated at 40 mg daily and tapered every 4 weeks to 10 mg; oral methotrexate was initiated at 15 mg weekly and increased by 5 mg weekly to a maximum dose of 25 mg.

At 24 weeks, methotrexate was noninferior to prednisone for increasing forced vital capacity (FVC). However, m…