Merenkova I. Immunosupressive therapy of patients with pulmonary sarcoidosis: prescriptions, regimens, effectiveness, tolerability, and algorithm of personified application

Object of study: pulmonary sarcoidosis; the aim: to develop an algorithm for personalized therapy of patients with pulmonary sarcoidosis based on the results of the study of the efficacy and tolerability of cytotoxic agents and the definition of an optimal drug for immunosuppressive therapy, taking into account contraindications, serious side effects and cases of glucocorticosteroid (GCS) resistance; research methods: clinical, computed tomography of the chest cavity, spirometry, bodipletismography, determination of diffusion capacity of the lungs; statistical; novelty: it has been determined that the use of immunosuppressants is shown in 32,4 % of patients with pulmonary sarcoidosis; studied the efficacy and tolerability of azathioprine, leflunomide and methotrexate and found that methotrexate is a drug of choice for patients with pulmonary sarcoidosis with contraindications and serious side effects of GCS therapy, both in terms of effectiveness and safety profiles; it has been determined that in patients with sarcoidosis resistant to GCS, monotherapy with methotrexate in 71,4 % of patients is ineffective; it has been established that combined therapy with methylprednisolone and methotrexate in patients with GCS-resistant sarcoidosis is effective on average 77 %; developed algorithm for treatment of patients with pulmonary sarcoidosis, taking into account contraindications for appointment, serious side effects of GCS and resistance to GCS therapy; a significantly higher incidence of relapses in patients with sarcoidosis after GCS was determined, than in patients with spontaneous regression of the disease and after methotrexate therapy. The field of application is medicine.