From the Guidelines
The primary treatment for pulmonary sarcoidosis is oral corticosteroids, typically prednisone, which should be used to improve and/or preserve forced vital capacity (FVC) and quality of life (QoL) in patients with major involvement from pulmonary sarcoidosis believed to be at higher risk of future mortality or permanent disability from sarcoidosis. According to the European Respiratory Journal study 1, for untreated patients with major involvement from pulmonary sarcoidosis, the introduction of glucocorticoid treatment is recommended to improve and/or preserve FVC and QoL.
Some key points to consider when treating pulmonary sarcoidosis include:
- Starting with 20-40 mg of prednisone daily for 6-8 weeks, then gradually tapering the dose over several months to reduce inflammation and prevent lung damage
- Using inhaled corticosteroids like budesonide for mild cases
- Adding immunosuppressants such as methotrexate (10-25 mg weekly) or azathioprine (50-200 mg daily) in more severe or resistant cases to reduce steroid dependence and manage long-term symptoms
- Monitoring lung function regularly with pulmonary function tests and chest X-rays
- Being aware of potential side effects from corticosteroids, including weight gain, osteoporosis, and diabetes, and prescribing calcium and vitamin D supplements to protect bone health
- Considering biologics like infliximab or adalimumab for patients who don't respond to or can't tolerate standard treatments
Non-pharmacological interventions are also important, including:
- Encouraging patients to quit smoking, as it can worsen lung inflammation
- Pulmonary rehabilitation exercises to help improve lung function and quality of life
- Regular follow-ups to assess treatment response and adjust the regimen as needed, with the goal of achieving remission or stable disease with the lowest effective medication dose. The European Respiratory Review study 2 also suggests a treatment algorithm for pulmonary sarcoidosis, which includes escalation of care based on disease progression and weaning prednisone to the lowest tolerable dose.
From the FDA Drug Label
Symptomatic sarcoidosis The treatment option for pulmonary sarcoidosis is prednisone (PO), as it is indicated for symptomatic sarcoidosis 3.
- The drug is used to treat various conditions, including respiratory diseases such as symptomatic sarcoidosis.
- Prednisone (PO) is a treatment option for managing symptoms of pulmonary sarcoidosis.
From the Research
Treatment Options for Pulmonary Sarcoidosis
The treatment options for pulmonary sarcoidosis include:
- Glucocorticosteroids, which are the "drugs of choice" for treatment of sarcoidosis 4
- Inhaled steroids, which can be used during the maintenance phase for treatment of pulmonary sarcoidosis 4, 5
- Alternative drugs, such as methotrexate, azathioprine, chlorambucil, and cyclophosphamide, which may be effective in sarcoidosis and have a steroid-sparing capacity 4, 5, 6, 7
- Antimalarials, such as chloroquine and hydroxychloroquine, which can be used for chronic skin lesions and hypercalcemia associated with sarcoidosis 4, 5
- Biologic agents, such as infliximab, which have proved effective in patients who have failed other treatments 5, 6, 7
Corticosteroid Therapy
Corticosteroid therapy for pulmonary sarcoidosis involves:
- Initial high doses to control inflammation 8
- Tapering to a maintenance dose that will continue to suppress the inflammation but lessen the risk of corticosteroid toxic reactions 8
- Continuing to receive the maintenance dose until a decision to taper off corticosteroids is made 8
- Tapering off corticosteroid therapy 8
- Observation for relapse 8
- Treatment if relapse occurs 8
Alternative Treatment Approaches
Alternative treatment approaches for pulmonary sarcoidosis include:
- Antimetabolites, such as methotrexate, azathioprine, leflunomide, and mycophenolate, which can be used as alternatives to steroids 6, 7
- Anti-tumour necrosis factor (TNF) monoclonal antibodies, which have been shown to control disease in patients who cannot be treated with low-dose glucocorticoids and an antimetabolite 7
- New strategies, such as rituximab, which may be effective in patients who have failed other treatments 7
- Combination therapy with four antibiotics (levofloxacin, ethambutol, azithromycin, and rifamycin), which has shown some promise in preliminary studies 7