From the Guidelines
Angiotensin-converting enzyme (ACE) inhibitors are not typically used as a primary treatment for sarcoidosis. The standard first-line treatment for symptomatic sarcoidosis is corticosteroids, usually prednisone starting at 20-40 mg daily for 1-3 months, followed by a gradual taper over 6-12 months depending on response, as suggested by recent guidelines 1. For patients who cannot tolerate steroids or who have refractory disease, second-line options include methotrexate (10-25 mg weekly), hydroxychloroquine (200-400 mg daily), or TNF inhibitors like infliximab (3-5 mg/kg IV at weeks 0,2, and 6, then every 4-8 weeks).
Key Points to Consider
- While ACE levels are often elevated in sarcoidosis patients and can be used as a biomarker to monitor disease activity, ACE inhibitors themselves do not treat the underlying inflammatory process of sarcoidosis 1.
- Using ACE inhibitors in sarcoidosis patients may interfere with using serum ACE levels as a biomarker for disease monitoring.
- Patients with sarcoidosis should be evaluated by a pulmonologist or rheumatologist to determine the appropriate treatment based on organ involvement and disease severity, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
Treatment Approach
- The treatment approach should be individualized, taking into account the severity of the disease, organ involvement, and the patient's overall health status.
- Regular monitoring of lung function every 6-12 months is essential to assess disease progression and adjust treatment accordingly 1.
From the Research
Ace for Sarcoidosis
- Angiotensin-Converting Enzyme (ACE) is a biomarker used in the diagnosis and follow-up of sarcoidosis patients, although its sensitivity and specificity are low 2, 3.
- ACE is produced mainly by activated alveolar macrophages and is elevated in sarcoidosis patients 2, 4.
- The diagnostic utility of ACE for sarcoidosis has been investigated in several studies, with results showing a poor sensitivity and insufficient specificity of high ACE for diagnosis of sarcoidosis 3.
- ACE levels can be affected by concomitant ACE-inhibitor therapies, with patients treated with ACEIs showing a progressive reduction in ACE levels over time 2.
- The use of ACEIs and Angiotensin Receptor Blockers (ARBs) in patients with sarcoidosis has been shown to have divergent effects on outcomes, with ACEIs associated with increased mortality risk and worse cardiac and respiratory outcomes 5.
- An optimized fluorescent kinetic assay for ACE activity has been developed, which can aid in the accurate diagnosis of sarcoidosis, especially when combined with ACE I/D genotype determination 6.
- The assay has shown a sensitivity of 42.5% and a specificity of 100% in a clinical study, making it a potential alternative to invasive biopsy for confirming the diagnosis of sarcoidosis in a significant percentage of patients 6.