From the Guidelines
The treatment for sarcoidosis should be individualized based on symptom severity and organ involvement, with corticosteroids like prednisone being the first-line therapy, and immunosuppressants like methotrexate and TNF-alpha inhibitors like infliximab being used in cases of inadequate response or severe disease, as recommended by the most recent European Respiratory Society guidelines 1.
Treatment Approach
The treatment approach for sarcoidosis varies depending on the severity of symptoms and organ involvement. For mild cases with no significant symptoms, a "watch and wait" approach may be sufficient with regular monitoring.
- When treatment is needed, corticosteroids like prednisone (typically starting at 20-40mg daily) are the first-line therapy, usually continued for 6-12 months with gradual tapering.
- For patients who cannot tolerate steroids or have inadequate response, immunosuppressants such as methotrexate (10-25mg weekly), azathioprine (50-200mg daily), or hydroxychloroquine (200-400mg daily) may be used.
- For severe or refractory cases, TNF-alpha inhibitors like infliximab (3-5mg/kg IV every 4-8 weeks) can be effective.
Organ-Specific Treatments
Organ-specific treatments may be necessary, such as:
- Inhaled corticosteroids for pulmonary symptoms
- Topical steroids for skin lesions
Treatment Goals
Treatment aims to reduce inflammation, prevent organ damage, and manage symptoms. The disease course is unpredictable, with about 60% of patients experiencing spontaneous remission within 2-5 years, while others require long-term therapy.
Monitoring
Regular follow-up with pulmonary function tests, eye exams, and other organ-specific monitoring is essential regardless of treatment approach, as recommended by the European Respiratory Society guidelines 1.
From the FDA Drug Label
Symptomatic sarcoidosis The treatment for sarcoidosis is prednisone (PO), as it is indicated for symptomatic sarcoidosis 2.
From the Research
Treatment Options for Sarcoidosis
- Corticosteroids are the cornerstone of treatment for sarcoidosis, allowing for disease remission, but only with a suspensive effect 3, 4, 5
- Immunosuppressive drugs, such as methotrexate and azathioprine, may be useful in patients with failure or contra-indication of corticosteroids, or in those who need a long-term prednisone dose higher than 10 mg daily to control the sarcoidosis 3, 6, 7
- Hydroxychloroquine and infliximab can be useful in some patients, particularly those with extensive skin lesions or severe sarcoidosis refractory to classical treatment 3, 6
- Topical corticosteroids can be used for limited skin involvement, anterior uveitis, or cough 3
Treatment Approach
- Treatment duration should be at least 12 months 3
- The main indications for systemic treatment include ophthalmologic, neurologic, cardiovascular, renal, laryngeal involvements, severe pulmonary manifestations, lupus pernio, and marked hypercalcaemia 3, 5
- Patients should initially receive prednisone or prednisolone at 0.5 to 1 mg/kg daily for 6 to 12 weeks to obtain a complete remission, followed by a gradual dose reduction every 6 to 12 weeks 3
- After treatment completion, a 36-month duration monitoring is warranted to confirm recovery 3