Treatments for pulmonary sarcoidosis
Identifieur interne : 001A38 ( Main/Exploration ); précédent : 001A37; suivant : 001A39Treatments for pulmonary sarcoidosis
Auteurs : Shanthi Paramothayan [Royaume-Uni] ; Toby Lasserson [Royaume-Uni]Source :
- Respiratory medicine [ 0954-6111 ] ; 2008.
Descripteurs français
- KwdFr :
- Cytotoxines (effets indésirables), Cytotoxines (usage thérapeutique), Essais contrôlés randomisés comme sujet, Fibrose pulmonaire (), Hormones corticosurrénaliennes (effets indésirables), Hormones corticosurrénaliennes (usage thérapeutique), Humains, Immunosuppresseurs (usage thérapeutique), Médecine factuelle (), Résultat thérapeutique, Sarcoïdose pulmonaire (traitement médicamenteux), Études de suivi.
- MESH :
- effets indésirables : Cytotoxines, Hormones corticosurrénaliennes.
- traitement médicamenteux : Sarcoïdose pulmonaire.
- usage thérapeutique : Cytotoxines, Hormones corticosurrénaliennes, Immunosuppresseurs.
- Pascal (Inist)
English descriptors
- KwdEn :
- Adrenal Cortex Hormones (adverse effects), Adrenal Cortex Hormones (therapeutic use), Antineoplastic agent, Corticosteroid, Cytotoxins (adverse effects), Cytotoxins (therapeutic use), Evidence-Based Medicine (methods), Evidence-based medicine, Follow-Up Studies, Humans, Immunosuppressive Agents (therapeutic use), Immunosuppressive agent, Lung, Pneumology, Pulmonary Fibrosis (prevention & control), Randomized Controlled Trials as Topic, Sarcoidosis, Sarcoidosis, Pulmonary (drug therapy), Systematic review, Treatment, Treatment Outcome.
- MESH :
- chemical , adverse effects : Adrenal Cortex Hormones, Cytotoxins.
- chemical , therapeutic use : Adrenal Cortex Hormones, Cytotoxins, Immunosuppressive Agents.
- drug therapy : Sarcoidosis, Pulmonary.
- methods : Evidence-Based Medicine.
- prevention & control : Pulmonary Fibrosis.
- Follow-Up Studies, Humans, Randomized Controlled Trials as Topic, Treatment Outcome.
Abstract
Corticosteroids (oral or inhaled) are commonly used to treat pulmonary sarcoidosis; however, there is no consensus about when to start treatment, what dose of steroids to give and for how long. Immunosuppressive and cytotoxic agents (used in immunosuppressive doses) are used in addition to oral corticosteroids to treat multisystem and chronic sarcoidosis, or as steroid-sparing agents. We summarize the findings from two Cochrane systematic reviews that have examined the efficacy of corticosteroids and immunosuppressive and cytotoxic drugs in the treatment of pulmonary sarcoidosis. Studies of corticosteroids differed in outcome measures, dose of drug given and length of treatment. For many outcome measures, data could not be pooled for meta-analysis. Oral corticosteroids improved chest X-ray appearance over 3-24 months, with improvement in global score in one study. Little evidence was found of improvement in lung function or of any long-term disease-modifying effect. Follow-up data could not be analysed. Inhaled corticosteroids improved symptoms in one small study but not lung function or chest X-ray. Side-effects of steroids were not well reported. In the immunosuppressive and cytotoxics review, no data could be combined for meta-analysis. Data on lung function, chest X-ray and dyspnoea were largely inconclusive. Methotrexate had a steroid-sparing effect in one small study. Significant adverse events were associated with cyclosporine A, chloroquine and pentoxifylline. Evidence from randomized-controlled trials (RCTs) supporting the use of immunosuppressive and cytotoxic agents is limited.
Affiliations:
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Le document en format XML
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last="Paramothayan">Shanthi Paramothayan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>St. Helier University Hospital, Wrythe Lane</s1><s2>Carshalton, Surrey SM5 1AA</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Carshalton, Surrey SM5 1AA</wicri:noRegion></affiliation></author><author><name sortKey="Lasserson, Toby" sort="Lasserson, Toby" uniqKey="Lasserson T" first="Toby" last="Lasserson">Toby Lasserson</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Division of Community Health Sciences, St. George's Hospital University of London</s1><s2>London</s2><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author></analytic><series><title level="j" type="main">Respiratory medicine</title><title level="j" type="abbreviated">Respir. med.</title><idno type="ISSN">0954-6111</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Respiratory medicine</title><title level="j" type="abbreviated">Respir. med.</title><idno type="ISSN">0954-6111</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adrenal Cortex Hormones (adverse effects)</term><term>Adrenal Cortex Hormones (therapeutic use)</term><term>Antineoplastic agent</term><term>Corticosteroid</term><term>Cytotoxins (adverse effects)</term><term>Cytotoxins (therapeutic use)</term><term>Evidence-Based Medicine (methods)</term><term>Evidence-based medicine</term><term>Follow-Up Studies</term><term>Humans</term><term>Immunosuppressive Agents (therapeutic use)</term><term>Immunosuppressive agent</term><term>Lung</term><term>Pneumology</term><term>Pulmonary Fibrosis (prevention & control)</term><term>Randomized Controlled Trials as Topic</term><term>Sarcoidosis</term><term>Sarcoidosis, Pulmonary (drug therapy)</term><term>Systematic review</term><term>Treatment</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Cytotoxines (effets indésirables)</term><term>Cytotoxines (usage thérapeutique)</term><term>Essais contrôlés randomisés comme sujet</term><term>Fibrose pulmonaire ()</term><term>Hormones corticosurrénaliennes (effets indésirables)</term><term>Hormones corticosurrénaliennes (usage thérapeutique)</term><term>Humains</term><term>Immunosuppresseurs (usage thérapeutique)</term><term>Médecine factuelle ()</term><term>Résultat thérapeutique</term><term>Sarcoïdose pulmonaire (traitement médicamenteux)</term><term>Études de suivi</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Adrenal Cortex Hormones</term><term>Cytotoxins</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Adrenal Cortex Hormones</term><term>Cytotoxins</term><term>Immunosuppressive Agents</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Sarcoidosis, Pulmonary</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Cytotoxines</term><term>Hormones corticosurrénaliennes</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Evidence-Based Medicine</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Pulmonary Fibrosis</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Sarcoïdose pulmonaire</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Cytotoxines</term><term>Hormones corticosurrénaliennes</term><term>Immunosuppresseurs</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Follow-Up Studies</term><term>Humans</term><term>Randomized Controlled Trials as Topic</term><term>Treatment Outcome</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Essais contrôlés randomisés comme sujet</term><term>Fibrose pulmonaire</term><term>Humains</term><term>Médecine factuelle</term><term>Résultat thérapeutique</term><term>Sarcoïdose</term><term>Traitement</term><term>Poumon</term><term>Corticostéroïde</term><term>Immunodépresseur</term><term>Anticancéreux</term><term>Revue systématique</term><term>Médecine factuelle</term><term>Pneumologie</term><term>Études de suivi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Corticosteroids (oral or inhaled) are commonly used to treat pulmonary sarcoidosis; however, there is no consensus about when to start treatment, what dose of steroids to give and for how long. Immunosuppressive and cytotoxic agents (used in immunosuppressive doses) are used in addition to oral corticosteroids to treat multisystem and chronic sarcoidosis, or as steroid-sparing agents. We summarize the findings from two Cochrane systematic reviews that have examined the efficacy of corticosteroids and immunosuppressive and cytotoxic drugs in the treatment of pulmonary sarcoidosis. Studies of corticosteroids differed in outcome measures, dose of drug given and length of treatment. For many outcome measures, data could not be pooled for meta-analysis. Oral corticosteroids improved chest X-ray appearance over 3-24 months, with improvement in global score in one study. Little evidence was found of improvement in lung function or of any long-term disease-modifying effect. Follow-up data could not be analysed. Inhaled corticosteroids improved symptoms in one small study but not lung function or chest X-ray. Side-effects of steroids were not well reported. In the immunosuppressive and cytotoxics review, no data could be combined for meta-analysis. Data on lung function, chest X-ray and dyspnoea were largely inconclusive. Methotrexate had a steroid-sparing effect in one small study. Significant adverse events were associated with cyclosporine A, chloroquine and pentoxifylline. Evidence from randomized-controlled trials (RCTs) supporting the use of immunosuppressive and cytotoxic agents is limited.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement><orgName><li>Université de Londres</li></orgName></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Paramothayan, Shanthi" sort="Paramothayan, Shanthi" uniqKey="Paramothayan S" first="Shanthi" last="Paramothayan">Shanthi Paramothayan</name></noRegion><name sortKey="Lasserson, Toby" sort="Lasserson, Toby" uniqKey="Lasserson T" first="Toby" last="Lasserson">Toby Lasserson</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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