EFFICIENCY AND SAFETY OF LEFLUNOMIDE TREATMENT IN PATIENTS WITH PULMONARY SARCOIDOSIS
Patients who have contraindications to the prescription of GCs (glucocorticosteroids), or have developed serious side effects during treatment with GCs, as well as patients with resistance to GCs therapy, are prescribed immunosuppressants.
The aim of the research - to study the efficacy of leflunomide monotherapy in patients with pulmonary sarcoidosis with contraindications to prescription or serious side effects of glucocorticosteroids.
Fourteen patients with sarcoidosis of the respiratory system of stage II were examined – 12 women and 2 men aged 30 to 69 years. In 10 patients there were contraindications to the appointment of GCs (diabetes mellitus – 5, hypertension – 3, obesity – 1, exacerbation of gastric ulcer – 1), which caused the appointment of immunosuppressive therapy as a starting. In 4 cases, serious side effects of SCs were noted, requiring the drug to be abolished (osteoporosis – 3, steroid diabetes – 1). Leflunomide was administered at a dose of 20 mg per day, daily for 3 months. The evaluation of efficacy was carried out using computed tomography of the thoracic cavity organs, body plethysmography, spirometry and determination of the diffusivity of the lungs.
Monotherapy with leflunomide in patients with contraindications to prescription or serious side effects of GCs was successful in 7 out of 13 patients, in 2 patients there was a stabilization of the process, in 4 patients with leflunomide therapy progression of the disease was noted and in 1 case the treatment was discontinued due to serious side effects of preparation.
The results obtained make it possible to recommend the use of leflunomide as monotherapy in patients with pulmonary sarcoidosis with contraindications to the prescription and/or poor tolerability of GCs and methotrexate. It is necessary to continue studying the possibilities of combined use of leflunomide with other drugs of the first line.
Grutters, J. C., van den Bosch, J. M. M. (2006). Corticosteroid treatment in sarcoidosis. European Respiratory Journal, 28 (3), 627–636. doi: 10.1183/09031936.06.00105805
Coker, R. K. (2007). Guidelines for the Use of Corticosteroids in the Treatment of Pulmonary Sarcoidosis. Drugs, 67 (8), 1139–1147. doi: 10.2165/00003495-200767080-00004
Baughman, R. P., Costabel, U., du Bois, R. M. (2008). Treatment of Sarcoidosis. Clinics in Chest Medicine, 29 (3), 533–548. doi: 10.1016/j.ccm.2008.03.012
Lazar, C., Culver, D. (2010). Treatment of Sarcoidosis. Seminars in Respiratory and Critical Care Medicine, 31 (4), 501–518. doi: 10.1055/s-0030-1262218
Korsten, P., Strohmayer, K., Baughman, R. P., Sweiss, N. J. (2016). Refractory pulmonary sarcoidosis – proposal of definition and recommendation for the diagnostic and therapeutic approach. Clinical Pulmonary Medicine, 23 (2), 67–75. doi: 10.1097/cpm.0000000000000136
Amin, E. N., Closser, D. R., Crouser, E. D. (2014). Current best practice in the management of pulmonary and systemic sarcoidosis. Therapeutic Advances in Respiratory Disease, 8 (4), 111–132. doi: 10.1177/1753465814537367
Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy «Sarkoidoz» (2014). MOZ Ukrainy No. 634. Available at: http://www.mif-ua.com/archive/article/39499
Judson, M. A. (2012). The treatment of pulmonary sarcoidosis. Respiratory Medicine, 106 (10), 1351–1361. doi: 10.1016/j.rmed.2012.01.013
Sakellariou, G. T., Anastasilakis, A. D., Karanikolas, D., Vounotrypidis, P., Berberidis, C. (2012). Central skeletal sarcoidosis: a case report with sustained remission only on methotrexate, and a literature review on the imaging approach, treatment, and assessment of disease activity. Modern Rheumatology, 23 (1), 175–181. doi: 10.1007/s10165-012-0631-z
Alemdaroglu, E., Erturk, A., Eroglu, A. G. (2010). A sarcoidosis patient with hand involvement and large pulmonary lymph nodes: results of 1-year treatment with methotrexate. Clinical Rheumatology, 32, 71–73. doi: 10.1007/s10067-010-1487-2
Beegle, S. H., Barba, K., Gobunsuy, R., Judson, M. A. (2013). Current and emerging pharmacological treatments for sarcoidosis: a review. Drug Design, Development and Therapy, 7, 325–338. doi: 10.2147/dddt.s31064
Cremers, J. P., Drent, M., Bast, A., Shigemitsu, H., Baughman, R. P., Valeyre, D. et. al. (2013). Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis. Current Opinion in Pulmonary Medicine, 19 (5), 545–561. doi: 10.1097/mcp.0b013e3283642a7a
Baughman, R. P., Lower, E. E. (2004). Leflunomide for chronic sarcoidosis. Sarcoidosis, Vasculitis and Diffuse Lung Diseases, 21 (1), 43–48.
Majithia, V., Sanders, S., Harisdangkul, V. et. al. (2003). Successful treatment of sarcoidosis with leflunomide. Rheumatology, 42 (5), 700–702. doi: 10.1093/rheumatology/keg156
Sweiss, N., Yeager, H. (2010). Sarcoidosis requiring systemic treatment: why not a steroid-sparing regimen up-front? Sarcoidosis, Vasculitis and Diffuse Lung Diseases, 27 (1), 3–4.
Sahoo, D. H., Bandyopadhyay, D., Xu, M., Pearson, K., Parambil, J. G., Lazar, C. A. et. al. (2011). Effectiveness and safety of leflunomide for pulmonary and extrapulmonary sarcoidosis. European Respiratory Journal, 38 (5), 1145–1150. doi: 10.1183/09031936.00195010
Joint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee (1999). American Journal of Respiratory and Critical Care Medicine, 160, 736–755.
Veltkamp, M., Grutters, J. C. (2013). The Pulmonary Manifestations of Sarcoidosis. Pulmonary Sarcoidosis. New York: Humana Press, 19–39. doi: 10.1007/978-1-4614-8927-6_2
Nunes, H., Uzunhan, Y., Gille, T., Lamberto, C., Valeyre, D., Brillet, P.-Y. (2012). Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function. European Respiratory Journal, 40 (3), 750–765. doi: 10.1183/09031936.00025212
Naccache, J.-M., Lavole, A., Nunes, H., Lamberto, C., Letoumelin, P., Brauner, M. et. al. (2008). High-Resolution Computed Tomographic Imaging of Airways in Sarcoidosis Patients With Airflow Obstruction. Journal of Computer Assisted Tomography, 32 (6), 905–912. doi: 10.1097/rct.0b013e31815b63dd
Copyright (c) 2018 Volodymyr Gavrysiuk, Ievgeniia Merenkova, Galyna Gumeniuk
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons CC BY, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.