From the Guidelines
Treatment for sarcoidosis is indicated when patients have symptomatic disease, particularly with organ dysfunction or progressive disease, as stated in the European Respiratory Journal study 1. The decision to treat sarcoidosis depends on two major factors: risk for death or organ failure and impairment of quality of life (QoL) 1. Some key points to consider when treating sarcoidosis include:
- Corticosteroids are the first-line therapy, typically starting with prednisone 20-40 mg daily for 1-3 months, followed by a gradual taper over 6-12 months 1.
- For pulmonary sarcoidosis, treatment is recommended for patients with significant symptoms, declining lung function (>10% decrease in FVC or 15% decrease in DLCO), or progressive radiographic changes 1.
- Extrapulmonary indications include cardiac involvement (arrhythmias, heart failure), neurosarcoidosis, ocular disease unresponsive to topical therapy, hypercalcemia, and significant skin or joint involvement 1.
- For steroid-sparing or refractory cases, methotrexate (10-25 mg weekly) is the preferred second-line agent, with alternatives including azathioprine, mycophenolate mofetil, leflunomide, or TNF-alpha inhibitors like infliximab 1.
- Treatment decisions should be individualized based on disease severity, organ involvement, and potential medication side effects 1.
- Many patients with mild, asymptomatic disease may not require treatment as sarcoidosis can spontaneously remit in 30-60% of cases within 2-5 years 1. It's essential to weigh the benefits and risks of treatment, considering the potential toxicity of prolonged corticosteroid use and the importance of improving quality of life for patients with symptomatic disease 1.
From the FDA Drug Label
7 Respiratory Diseases Symptomatic sarcoidosis The indication of treatment for sarcoidosis is for symptomatic cases.
- The treatment is prednisone (PO). 2
From the Research
Indications for Treatment in Sarcoidosis
- The main indications for systemic treatment in sarcoidosis include ophthalmologic, neurologic, cardiovascular, renal, laryngeal involvements, severe pulmonary manifestations, lupus pernio, and marked hypercalcaemia 3.
- Treatment is necessary for patients with disease flare, and the duration of treatment should be at least 12 months 3.
- Corticosteroids are the drug of choice for the treatment of sarcoidosis, but treatment is not mandatory due to the potential for self-limiting disease or no long-term harm 4.
Treatment Options
- Corticosteroids, such as prednisone or prednisolone, are the initial treatment of choice for most patients, with a recommended dose of 0.5 to 1 mg/kg daily for 6 to 12 weeks 3.
- Immunosuppressive drugs, such as methotrexate, azathioprine, leflunomide, and mycophenolate, can be used as second-line therapy or for patients with failure or contraindication of corticosteroids 3, 5, 6.
- Biologics, such as infliximab, can be used as third-line therapy for advanced disease or for patients refractory to classical treatment 3, 5.
- Hydroxychloroquine and chloroquine can be used for extensive skin lesions or as corticosteroid-sparing agents 3, 6.
Specific Treatment Considerations
- For patients with pulmonary sarcoidosis, oral glucocorticoids, such as prednisone, can be used at a dose of 20 mg/d to 40 mg/d for 2 to 6 weeks, with tapering over 6 to 18 months if symptoms improve 7.
- For patients with precapillary pulmonary hypertension, therapies such as phosphodiesterase inhibitors and prostacyclin analogues can be used 7.
- For patients with advanced fibrocystic pulmonary disease, effective treatments are not available 7.