Study Reveals Methotrexate Comparable to Prednisone for Pulmonary Sarcoidosis Treatment

Recent research presented at the ATS 2025 International Conference indicates that methotrexate may serve as an effective alternative to prednisone for treating pulmonary sarcoidosis, a condition often managed with this commonly prescribed steroid. The findings were published in the American Journal of Respiratory and Critical Care Medicine.

Prednisone has long been recognized as the standard treatment for pulmonary sarcoidosis; however, it is associated with several adverse effects, including weight gain, sleep disturbances, and psychological issues. The new study, which involved a randomized, controlled trial across 17 hospitals in the Netherlands, offers robust evidence comparing the efficacy of methotrexate and prednisone.

In the trial, a total of 137 patients were enrolled, with 69 receiving prednisone and 68 treated with methotrexate. The results demonstrated that methotrexate was non-inferior to prednisone after a treatment period of 24 weeks. Although the onset of effectiveness was slower with methotrexate, the overall incidence of side effects was similar between the two groups. Notably, the methotrexate cohort reported fewer ongoing side effects at the 24-week mark.

Participants treated with prednisone experienced more common side effects such as weight gain, insomnia, and increased appetite. In contrast, those on methotrexate frequently reported nausea, fatigue, and liver function abnormalities.

The study's authors expressed surprise at the early symptom improvement observed in the methotrexate group, which appeared as early as four weeks into the treatment. This finding highlights the potential for personalized treatment plans, as individual patient preferences and concerns regarding side effects can significantly influence treatment decisions.

Future research endeavors will focus on developing decision-support tools to assist healthcare professionals and patients in navigating treatment options. Additionally, follow-up studies aim to analyze blood samples from participants to identify cellular biomarkers that could predict individual responses to therapy.

Sarcoidosis is a complex immunological disorder characterized by varied clinical responses, with some individuals experiencing spontaneous remission while others require immunosuppressive therapies to preserve organ function and enhance quality of life. The outcomes of this study may encourage healthcare providers to consider methotrexate as a viable treatment option, aligning with patient-centered care approaches.