Sarcoidosis Drugs - Effectiveness & Side Effects
Medications are used to treat sarcoidosis. Most sarcoidosis medications are used to suppress the immune system.
An abnormal response from the immune system is thought be involved in sarcoidosis (see What is sarcoidosis?).
However, there are disadvantages when using medication to suppress the immune system:
- By suppressing the immune system, the body's defenses are lowered and a person has a greater risk of infection from other diseases
- Sarcoidosis medications are usually strong and can have bad side effects.
Sarcoidosis - types of medication
Prednisone is a drug most often used to treat sarcoidosis. A corticosteroid, prednisone is used to relieve tissue inflammation (a common symptom of sarcoidosis). People with sarcoidosis normally respond to the effects of prednisone. Those who show no response to prednisone after a few months of treatment may:
- have been wrongly diagnosed as having sarcoidosis
- already have scarring and sarcoidosis won't improve with this type of treatment.
Prednisone treatment can last several months to many years - the longer the duration of treatment the greater the chance that symptoms will not return.
However, prednisone can have bad side effects and the doctor and person with sarcoidosis must 'weigh up' the benefits from using this drug against possible side effects. Low doses of prednisone are often prescribed to relieve symptoms without causing significant side effects.
Prednisone side effects can include:
- high blood pressure
- weight gain
- mood swings
- sleep disturbance
Long term treatment using prednisone can lead to other side effects:
- osteoporosis - thinning of the bones & skin
Hydroxychloroquine (brand name: Plaquenil) is another drug with anti-inflammatory properties. It is used to treat a number of other diseases including malaria, rheumatoid arthritis and lupus erythematosus.
Hydroxychloroquine is more effective at treating sarcoidosis of the skin and when blood calcium levels are high. There are fewer side effects with hydroxychloroquine compared to Prednisone. However, the drug is effective in only about a third of persons with sarcoidosis.
Hydroxychloroquine side effects include
- stomach irritation
- eye problems - it is recommended that people who take hydroxychloroquine have their eyes tested every 6 months
Methotrexate is another sarcoidosis medication which is also used to treat other diseases. These include cancer, psoriasis and rheumatoid arthritis. The drug works in a high percentage of people with sarcoidosis (about 60 to 80 percent).
However, it takes up to 6 months to relieve symptoms and methotrexate has side effects which can be dangerous or life-threatening.
Methotrexate side effects include:
- mouth sores
- an allergic reaction - can affect the lungs (rare)
- boils or acne
- joint pain
Methotrexate can also kill white bloods cells which are used by the immune system to fight off infection. People taking this drug should have regular blood tests to check white blood cell levels.
Long term use of methotrexate can lead to serious liver problems. If methotrexate is taken for more than 2 years a biopsy should be carried out on the liver to see if there is damage & if this treatment can still be used.
When methotrexate is taken in small doses side effects are usually limited.
Folic acid can be taken to reduce the chances of side effects.
Azathioprine (brand name: Imuran) is another multi-use drug & is used to treat a number of diseases including rheumatoid arthritis - its is also used with organ transplants. Azathioprine treatment lasts for 6 months or more. Azathioprine can improve the symptoms in about 50 percent of people with sarcoidosis.
Azathioprine side effects include:
- itchy rashes
- sore mouth, throat and/or ulcers
- skin becomes sensitive to ultraviolet light.
- a lowering of white blood cells - regular blood tests should be used to monitor white blood cell levels
Cyclophosphamide (brand name: Cytoxan) is a powerful drug. Due to its potentially life threatening side effects it is used only in people with severe forms of the disease (such as neurosarcoidosis).
Cyclophosphamide side effects include:
- irritation of the bladder
- lowering of white blood cells
- loss of appetite or weight
- bladder cancer - found in some people who have been taking cyclophosphamide for more than 2 years