Pulmonary sarcoidosis is considered refractory if
glucocorticoids (GCs) at a maintenance dose of at least 10 mg/day (
prednisolone equivalent) and
methotrexate (MTX), including their combined use, are not effective enough to achieve clinical remission. Aim - to study the rate of refractory
pulmonary sarcoidosis after conventional treatment with
methylprednisolone (MP) and/or MTX in patients with newly diagnosed disease. 250 patients with newly diagnosed
pulmonary sarcoidosis (106 men and 144 women; mean age 44 years) were examined. Radiological stage II was established in 237 (94.8%) patients, stage III - in 13 (5.2%). GCs
therapy was carried out using MP in 190 patients at an initial dose of 0.4 mg/kg/day for 4 weeks with a gradual decrease to a maintenance dose (0.1 mg/kg/day) by the end of the 6th month. In the presence of
contraindications or serious adverse effects of MP (60 patients), MTX was used at a dose of 15 mg/week. Patients without
contraindications and serious adverse effects of MP treated with MTX, in case of initial
therapy failure, were prescribed combined
therapy with MP (12 mg/day) and MTX (10 mg/week). Based on combination
therapy outcomes, as well as taking into account the cases of MTX
therapy failure in patients with
contraindications or serious adverse effects of GCs
therapy, refractory
pulmonary sarcoidosis was diagnosed in 27 (10.8%) patients. Patients with refractory
pulmonary sarcoidosis were more likely to have stage III disease (Pearson's χ2 test=5.766, p=0.018), as well as extrapulmonary lesions (χ2 test=4.672, p=0.031). The high rate of conventional
therapy failure using first- and second-line medications in patients with newly diagnosed
sarcoidosis determines the relevance of further study of the causes, development of risk criteria and new approaches to the treatment of refractory
pulmonary sarcoidosis.