Introduction: Sarcoidosis is a multiorgan granulomatosis recognized since the second half of the 19th century. For over 70 years, systemic glucocorticosteroids have remained the primary method of influencing the immune response in this disease. Accumulated experience has led to the need for further modification of treatment, and methotrexate holds great promise among second-line agents.

Objectives: To analyze the efficacy and safety of methotrexate as a second-line treatment in patients with sarcoidosis.

Materials and Methods: A longitudinal and cross-sectional observational study of 146 patients with pulmonary sarcoidosis receiving methotrexate for 3, 6, 10-12, and more than 12 months. Patients' general condition, spirometry, and computed tomography data were assessed. Analysis was performed using SPSS-18 (IBM, USA). Differences were considered significant at p < 0.05.

Results: The study primarily confirmed the efficacy and safety of MTT in sarcoidosis at a dose of 15 mg weekly, as recommended in the 2013 WASOG publication. Significant changes in both frequency and quantitative parameters were achieved beginning at month 6 of treatment. At this point, 60.7% reported improvement in their condition, and another 32.5% rated it as stable. Significant improvement in HRCT changes began as early as month 3. A significant indicator at all time points was a decrease in the size of the largest intrathoracic lymph node. After 10-12 months of treatment, only 2 patients (3.4%) showed negative dynamics, 51.7% showed improvement, and 44.8% had stable radiographic imaging. Spirometry parameters remained stable at month 6 in 79.8% of patients. The MTT discontinuation rate decreased from 16.1% at month 3 to 4.2% after one year.

Conclusions: The study confirmed the efficacy and safety of methotrexate as a second-line drug for sarcoidosis.