A group of Dutch researchers presented recent findings at the American Thoracic Society (ATS) 2025 International Conference. The abstract, “Methotrexate Versus Prednisone as First-line Treatment for Pulmonary Sarcoidosis: The PREDMETH Trial,” was published in the American Journal of Respiratory and Critical Care Medicine.
In the side-by-side comparison of prednisone (standard-of-care treatment) and methotrexate (alternative), researchers found the latter to be as effective in controlling the disease with potentially less intrusive side effects.
The randomized, controlled clinical trial (PREDMETH) was the first of its kind to compare the two therapies in people who have pulmonary sarcoidosis. It included 138 patients across 17 hospitals in the Netherlands, half received prednisone and the other half received methotrexate over the course of 24 weeks. The majority of participants were male (74.7%), and the average age was 46.6 years.
At the end of treatment, researchers determined methotrexate had a slower effectiveness but an equal overall success. The number of side effects was consistent between the drugs but varied in outcome. Patients in the methotrexate group experienced more nausea, fatigue and abdominal pain, while patients in the prednisone group were more likely to experience weight gain, insomnia and increased appetite.
First author Vivienne Kahlmann, MD, pulmonologist trainee at Erasmus Medical Center in Rotterdam, Netherlands, said the trial results confirm methotrexate as a viable fist-line alternative treatment to prednisone for the use in adults with pulmonary sarcoidosis.
“Some patients prioritize fast improvement of symptoms and are less afraid of side effects, while other patients may want to wait longer for treatment effects if this means they can avoid steroid toxicity,” Dr. Kahlmann said in a news release.
The research group plans to create a tool that aids in the decision-making process, so doctors and patients can collaborate on a personalized treatment plan, said study co-author Marlies Wijsenbeek, MD. There are also plans to conduct further trials to analyze patient blood samples and detect cellular biomarkers to predict treatment response.
