***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Ninety patients with sarcoidosis were enrolled in a r and omized trial of the effect of three months of prednisone therapy .  Eighty-three patients completed treatment and were followed for at least a year . in thirty-seven patients with hilar lymphadenopathy alone on admission to the study , no significant difference between treated and control groups was noted either at the end of the treatment period or after a mean interval of 5.2 years . in forty-six patients with pulmonary infiltration , significant improvement was evident at the end of the treatment period but no differences between treated patients and controls were demonstrable after a mean interval of 5.4 years . Subsequent relapse or progression necessitated prednisone therapy in 38 per cent of patients receiving placebo and 24 per cent of treated patients . the prognosis was significantly better in patients entering the study with hilar adenopathy alone . These observations support the views , widely but not universally held , that prednisone exerts little Sarcoidosis may cause severe ventilatory impairment requiring corticosteroid treatment . Chloroquine ( CQ ) can be an effective treatment for lung sarcoidosis with few side effects , but has not been accepted as st and ard therapy . We investigated the benefits of prolonged CQ therapy in 23 symptomatic patients with biopsy-proven pulmonary sarcoidosis ( duration , > /= 2 yr ) . Patients were initially treated for 6 mo with CQ , 750 mg/d , tapering every 2 mo to 250 mg/d . Eighteen patients were then r and omized to either a Maintenance group ( CQ , 250 mg/d ) or to an Observation group ( no CQ ) . After the initial treatment , significant improvement was observed in symptoms , pulmonary function , angiotensin-converting enzyme , and lung gallium scan . Patients r and omized to the Maintenance group showed a slower decline in pulmonary function ( FEV1 , 51.4 + /- 28.2 ml/yr [ Maintenance ] versus 196.3 + /- 33.4 ml/yr [ Observation ] , p < 0.02 ) and had fewer relapses : 2 of 10 patients in the Maintenance group at 29.5 + /- 4.9 mo versus 6 of 8 patients in the Observation group at 15.5 + /- 2.9 mo . Adverse effects were seen mainly during high-CQ dosage . We conclude that CQ should be an important consideration for the treatment and maintenance of chronic pulmonary sarcoidosis 117 patients with histologically confirmed mediastino-pulmonary sarcoidosis stage I and II without extrapulmonary manifestations were included in a controlled therapeutic trial . 92 patients remained for analysis . Among these 54 were treated for 6 or 12 months with prednisolone and isoniacid ; 38 were not treated . 6 and 12 months after beginning the observation , improvement was more frequent in the treated group . After 3 years and 5 years ( 45 patients only ) however differences were no more evident : improvement was observed in about 80 per cent , complete remission in about 65 per cent in treated and untreated patients . In both groups , patients presenting dissemination in the lungs had worse results than those with hilo-mediastinal adenopathy associated or not with pulmonary dissemination . Prednisolone seems to have effects in the early phase of sarcoidosis but is apparently not so effective in respect to the general development of the illness and in preventing pulmonary fibrosis . Therefore strict indication for therapy with corticosteroids of sarcoidosis exist when progressive pulmonary dissemination and /or reduction of pulmonary function is evident Pulmonary sarcoidosis is a disease in which the pathological processes are distributed along lymphatic pathways , particularly those around the bronchovascular bundles . Delivery of disease-modulating drugs by the inhaled route is therefore an attractive option . The aim of this study was to determine the efficacy of inhaled fluticasone propionate 2 mg x day(-1 ) in adults with stable pulmonary sarcoidosis . Forty-four adult patients ( 22 from each centre ) were enrolled from outpatient clinics in two London teaching hospitals in a two centre , double-blind , r and omized , placebo-controlled trial . Primary end points were home recordings of peak expiratory flow rate ( PEFR ) , forced expiratory volume in one second ( FEV1 ) , and forced vital capacity ( FVC ) . Secondary end points were symptom scores , use of rescue bronchodilator medication , and clinic values for PEFR , FEV1 , FVC , forced mid-expiratory flow ( FEF25 - 75 % ) , diffusion capacity of the lung for carbon monoxide ( DL , CO ) , and total lung capacity ( TLC ) . Symptom scores of cough , breathlessness and wheeze were lower in the active treatment group , but this did not reach statistical significance , and a general health perception assessment ( Short Form (SF)-36 ) showed a difference between active and placebo treatment . No significant differences were found between the two groups in any physiological outcome measure . No new adverse reactions were detected . The results of this pilot study do not show an objective benefit of inhaled fluticasone propionate in pulmonary sarcoidosis where the disease is stable and is controlled without the use of inhaled corticosteroids Thirty-nine sarcoidosis patients with pulmonary infiltrations ( stage II ) of less than 5 years duration and not treated earlier with corticosteroids were r and omly allocated for treatment with methylprednisolone for 7 months or for observation without therapy . Every other treated patient was given the drugs daily and every other followed an alternate-day regimen . After 7 months the chest radiographic finding , the forced vital capacity and the diffusion capacity for carbon monoxide were superior in the treated group . There was no difference between the two drug regimens . After 24 and 48 months no statistically significant differences between the untreated and the treated groups were found OBJECTIVE To evaluate whether inhaled steroids in high doses might be of therapeutic value in pulmonary sarcoidosis . DESIGN R and omized , double blind and placebo controlled parallel study . SETTING The out-patient clinic of the Department of Pulmonary Medicine , Gentofte Hospital , Copenhagen , Denmark . SUBJECTS Twenty-one untreated patients ( 17 males , 4 females , median age 33 years , range 21 - 65 ) and eight patients treated with systemic prednisolone . All patients had biopsy proven pulmonary sarcoidosis radiological stage I-III . INTERVENTIONS Treatment with either inhaled budesonide 1.2 mg day-1 - 2.0 mg day-1 ( n = 9 ) or placebo ( n = 12 ) for 12 months . MAIN OUTCOME MEASURES Clinical ( cough , chest pain , dyspnoea ) and para clinical variables ( chest X-ray , gallium scintigraphy , pulmonary function tests , and biochemical markers of disease activity : blood leukocytes , lymphocytes , serum ( S- ) angiotensin converting enzyme ( ACE ) , S-1,25-OH-cholecalciferol , plasma ( P- ) calcium , P-immunoglobulins ) were recorded before treatment , every three months during treatment , and 6 months after treatment had been discontinued . RESULTS There were no significant differences between the recorded variables in the budesonide and placebo groups . In general , a regression of disease activity was observed in both groups . Two patients in the treatment group , treated with 2.0 mg budesonide/day , and two in the placebo group had progression in disease and were put on  systemic steroids . CONCLUSION Inhaled budesonide in doses of 1.2 - 2.0 mg day-1 had no recognizable therapeutic effect on pulmonary sarcoidosis BACKGROUND AND AIM OF THE WORK Methotrexate has been steroid sparing for some patients with chronic sarcoidosis . We wished to determine whether methotrexate can be steroid sparing in the first year of corticosteroid therapy in sarcoidosis . METHODS Patients with new onset , symptomatic disease within four weeks of starting on prednisone  were r and omized to receive either methotrexate or placebo for the next year . They were seen monthly and prednisone dosage was tapered following a pre-determined schedule . RESULTS Of 24 patients enrolled , only 15 received at least six months of therapy . Since methotrexate appears to take six months to be effective , only patients who completed six or more months of therapy were evaluated . The amount of prednisone per day decreased for both groups : methotrexate ( First 6 months : Median 26 ( Range 15 - 37 ) mg/day ) ; Second 6 months 8 ( 1 - 22 ) mg/day , p < 0.01 ) and placebo ( First 6 Months 28 ( 24 - 33 ) mg/day ; Second 6 months 16 ( 11 - 22 ) mg/day , p < 0.02 ) , with less prednisone used for the methotrexate patients versus placebo in the last six months ( p < 0.01 ) . There was also less weight gain for those patients receiving methotrexate . There was no difference in toxicity between methotrexate and placebo . The difference between methotrexate versus placebo was not seen when all patients ( including the dropouts ) were analyzed . CONCLUSIONS Methotrexate can be a steroid sparing agent in acute sarcoidosis STUDY OBJECTIVE To evaluate the efficacy of oral prednisolone , followed by inhaled budesonide , in patients with newly diagnosed ( <3 months ) stage I and stage II pulmonary sarcoidosis . DESIGN Double-blind , placebo-controlled , parallel-group , multicenter study . SETTING Twenty pulmonary medicine departments in Finl and . PATIENTS One hundred eighty-nine adult patients were r and omized to treatment . Patients with erythema nodosum or stage IV sarcoidosis ( pulmonary fibrosis ) , and patients requiring immediate treatment with oral corticosteroids for extrapulmonary lesions or chronic illnesses were excluded . TREATMENT The patients received either oral prednisolone for 3 months ( 20 mg/d for 8 weeks , 15 mg/d for 2 weeks , and 10 mg/d for 2 weeks ) followed by inhaled budesonide ( Pulmicort Turbuhaler ; Astra Draco ; Lund , Sweden ) for 15 months at 800 microg bid , or placebo tablets followed by placebo inhaler therapy . MEASUREMENTS Chest radiographs , lung volumes ( FVC ) , diffusing capacity of the lung for carbon monoxide ( D(LCO ) ) , serum angiotensin-converting enzyme ( SACE ) , and beta2-microglobulin at 3-month intervals . RESULTS After 3 months of treatment , radiographic improvements were seen in the active-treatment group when compared to the placebo-treatment group . At 6 months , the difference was still statistically significant . Later , no differences were found . In patients with initial stage I lesions , neither the FVC nor the D(LCO ) ( the percent predicted mean values ) changed during the study , as they were normal from the beginning . In patients with initial stage II disease , the difference in the FVC mean values between the groups also remained unchanged throughout the study . In stage II patients treated for 18 months , but not earlier , the difference in D(LCO ) became statistically significant ; the largest differences were seen in patients with initial FVC values < 80 % of predicted and D(LCO ) values < 75 % of predicted . The decrease in SACE in the active-treated stage II patients was significantly larger than in the placebo-treated patients . No difference was observed in adverse events between the active-treated patients and the placebo-treated patients . CONCLUSION Treatment is not required for patients with stage I disease . An initial treatment with prednisolone followed by long-term inhalation of budesonide is more effective than placebo in patients with stage II disease . Sequential oral and inhaled corticosteroid therapy may be an alternative treatment regimen for stage II sarcoidosis patients , rather than long-term oral corticosteroid therapy alone In a double-blind , placebo-controlled study , we assessed the efficacy of inhaled budesonide on the course of newly diagnosed pulmonary sarcoidosis and whether budesonide treatment could postpone oral corticosteroid treatment . We evaluated : 1 ) symptoms ; 2 ) chest radiography ; 3 ) angiotensin-converting enzyme ( ACE ) in serum ; and 4 ) lung function .  Patients with histologically confirmed pulmonary sarcoidosis with chest radiographic stages I , II or III , and with an abnormal lung function ( inspiratory vital capacity ( IVC ) < 79 % of predicted or transfer factor of the lungs for carbon monoxide ( TL , CO ) < 77 % pred ) were included . Patients with radiographic stage II or III but with normal lung function were included when more than 20 % of the total cell population in bronchoalveolar lavage fluid ( BALF ) was lymphocytes . Forty seven patients received placebo or budesonide ( 1.2 mg ) once daily via a Nebuhaler for 6 months , followed by 6 months without treatment . Based on predetermined criteria , 11 patients were excluded during the blind treatment period as they needed oral prednisone : seven ( 28 % ) patients in the placebo group ( n = 25 ) and four ( 18 % ) patients in the budesonide group ( n = 22 ) . Patient 's Global Clinical Impression ( GCI ) score showed a significant difference in favour of budesonide .  IVC showed a significant difference of 7. 
    Output:
    
Side-effects of steroids were not well reported .
Significant adverse events were associated with cyclosporine A , chloroquine and pentoxifylline .