Recent findings presented at the ATS 2025 International Conference suggest that methotrexate could serve as an effective alternative to prednisone for managing pulmonary sarcoidosis. This autoimmune condition, marked by its unpredictable progression and outcomes, often necessitates immunosuppressive therapy for some patients. While prednisone has been traditionally recommended as the standard treatment, it is associated with numerous side effects such as weight gain, sleep disturbances, and psychological symptoms. The PREDMETH trial, conducted across 17 Dutch hospitals, demonstrated that methotrexate offers comparable disease control with potentially fewer long-term complications. The study involved 137 participants split into two groups receiving either methotrexate or prednisone.

According to the research team, led by Dr. Vivienne Kahlmann from Erasmus Medical Center in Rotterdam, the trial provided the first robust evidence comparing these two therapies. Methotrexate exhibited non-inferiority to prednisone after 24 weeks of treatment but required more time to take effect. Although both treatments resulted in similar overall side effects, the nature of these issues varied significantly between groups. Prednisone users commonly experienced weight gain and insomnia, whereas those on methotrexate faced nausea and liver function anomalies.

Dr. Marlies Wijsenbeek, also from Erasmus Medical Center, highlighted that symptom improvements were observed earlier than anticipated in the methotrexate group. This revelation supports personalized treatment strategies, emphasizing the importance of tailoring options based on individual patient preferences. Some may value rapid symptom relief over potential side effects, while others might prefer delayed benefits if they can avoid steroid-related toxicity.

The research team intends to create a decision-support tool aimed at guiding both physicians and patients through treatment selection processes. Furthermore, future studies will explore cellular biomarkers within blood samples collected during the trial to predict responses to different therapies.

This groundbreaking study paves the way for more informed and customized treatment approaches in managing pulmonary sarcoidosis, offering hope for enhanced patient care and quality of life.