The place of systemic corticosteroids and methotrexate in the treatment of sarcoidosis: discussion of a new position
https://doi.org/10.18093/0869-0189-2026-36-3-480-488
Abstract
Sarcoidosis is a chronic inflammatory disease characterized by the formation of granulomas in various organs and body systems. It manifests with a variety of symptoms, involving lungs, joints, skin, eyes, and other organs.
The aim of this review was to discuss a new approach to long-term sarcoidosis therapy.
Results. Treatment of sarcoidosis includes various approaches aimed at suppressing inflammation and granulomatosis progression, and preventing complications such as organ and system failure and fibrosis, but each approach is advisory in nature. For over half a century, corticosteroids have remained the standard first-line treatment, but their long-term use is associated with serious side effects. Methotrexate and other immunosuppressants offer alternatives to corticosteroids and are used when the latter are ineffective or intolerable. However, the choice of drug is personalized. Long-term glucocorticoid use is associated with an increased risk of developing diabetes, hypertension, osteoporosis, and infections. Therefore, it is important to monitor side effects and promptly adjust treatment strategies.
Conclusion. The current position suggests switching to methotrexate after initial hormonal therapy, which provides long-term disease control with fewer side effects.
About the Authors
A. A. Vizel
Federal State Budgetary Educational Institution of Higher Education Kazan State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Aleksandr A. Vizel, Doctor of Medicine, Professor, Head of Department of Phthisiology and Pulmonology
ul. Butlerova 49, Kazan, 420012, Republic of Tatarstan
S. N. Avdeev
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation
Russian Federation
Sergey N. Avdeev, Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Director of the National Medical Research Center for Pulmonology; Head of the Department of Pulmonology, N.V.Sklifosovsky Institute of Clinical Medicine
ul. Trubetskaya 8, build. 2, Moscow, 119991
A. S. Belevskiy
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Andrey S. Belevskiy, Doctor of Medicine, Professor; Head of the Pulmonology Department, Faculty of Additional Professional Education Institute of Continuing Education and Professional Development
ul. Ostrovityanova 1, Moscow, 117997
I. Yu. Vizel
Federal State Budgetary Educational Institution of Higher Education Kazan State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Irina Yu. Vizel, Doctor of Medicine, Professor, Russian Academy of Natural Sciences, Professor, Department of Phthisiology and Pulmonology
ul. Butlerova 49, Kazan, 420012, Republic of Tatarstan
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For citations:
Vizel A.A., Avdeev S.N., Belevskiy A.S., Vizel I.Yu. The place of systemic corticosteroids and methotrexate in the treatment of sarcoidosis: discussion of a new position. PULMONOLOGIYA. 2026;36(3):480-488. (In Russ.) https://doi.org/10.18093/0869-0189-2026-36-3-480-488
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