How pentoxifylline works
In addition to improving blood flow, pentoxifylline inhibits the synthesis of a pro-inflammatory, or immune-activating factor, called TNF-alpha. Immune cells in the lungs respond to infection by secreting TNF-alpha, which signals other immune cells to attack the infection. By decreasing TNF-alpha signaling, pentoxifylline reduces the immune response.
In sarcoidosis, the immune system can be over-activated. This causes immune cells to cluster or clump together and form granulomas, which do not dissipate the way they should when the threat has been eliminated. These granulomas can cause scarring and interfere with the function of many tissues. Many sarcoidosis patients have granulomas form in their lungs.
Pentoxifylline in clinical trials
In a preliminary study, 23 untreated patients with active sarcoidosis were treated with pentoxifylline. The results were published in the American Journal of Respiratory and Critical Care Management. An improvement was noted in 11 patients, while seven patients remained stable, and none deteriorated. Three patients discontinued therapy because of gastrointestinal side effects. Three patients whose sarcoidosis was resistant to corticosteroids improved after adding pentoxifylline to corticosteroid treatment.
In a Phase 2 clinical trial (NCT00001877), 27 patients with pulmonary sarcoidosis were randomly assigned to receive either pentoxifylline with prednisone, a corticosteroid, or prednisone alone. The results were published in the scientific journal Sarcoidosis, Vasculitis, and Diffuse Lung Diseases.
No improvement was seen in lung function or shortness of breath. However, a retrospective analysis of the data found a slight reduction in sarcoidosis flares.
A study published in the European Respiratory Journal reported the results of a retrospective analysis looking at a combination of pentoxifylline and vitamin E to treat sarcoidosis. For six to 12 months, 275 patients were treated with 600-800 mg per day of pentoxifylline and 400 mg per day of vitamin E.
An improvement in symptoms was seen in 33% of patients while 19% of patients showed a deterioration of their symptoms. In 31% of patients, sarcoidosis relapsed after pentoxifylline treatment was stopped, and steroid therapy was introduced.
Adverse events were mostly mild, and included headache, dizziness, abdominal pain, and sleep disorders in 25% of patients.
The authors concluded that the combined use of pentoxifylline and vitamin E leads to an improvement or stabilization of sarcoidosis in two-thirds of newly diagnosed patients not previously treated with systemic corticosteroids.
Side effects of pentoxifylline are primarily gastrointestinal, and may include upset stomach, vomiting, and gas. Some patients may also experience headache and dizziness.
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