From the Guidelines
The primary treatment for pulmonary sarcoidosis is oral corticosteroids, typically starting with prednisone at a dose of 20-40 mg daily, as recommended by the European Respiratory Journal in 2021 1. The treatment approach for pulmonary sarcoidosis involves a step-wise escalation of therapy, starting with glucocorticoids, followed by the addition of immunosuppressive medications such as methotrexate or azathioprine, and finally biologics like infliximab in more severe or refractory cases, as suggested by the Delphi consensus recommendations in 2020 1. Some key points to consider in the treatment of pulmonary sarcoidosis include:
- The use of glucocorticoids as first-line therapy, with the goal of reducing inflammation and improving symptoms, as stated in the European Respiratory Journal in 2021 1.
- The addition of immunosuppressive medications such as methotrexate or azathioprine in patients who do not respond adequately to glucocorticoids or experience significant side effects, as recommended by the European Respiratory Review in 2020 1.
- The consideration of biologics like infliximab in more severe or refractory cases, as suggested by the Delphi consensus recommendations in 2020 1.
- The importance of monitoring lung function regularly with pulmonary function tests and chest imaging to assess treatment efficacy, as stated in the European Respiratory Journal in 2021 1.
- The need for patients to be aware of potential side effects from long-term corticosteroid use, including osteoporosis, diabetes, and increased infection risk, and to consider calcium and vitamin D supplementation to help prevent bone loss, as recommended by the European Respiratory Review in 2020 1. Non-pharmacological interventions, such as pulmonary rehabilitation and smoking cessation (if applicable), can also complement medical treatment and help improve lung function and overall quality of life for patients with pulmonary sarcoidosis, as stated in the European Respiratory Journal in 2021 1.
From the FDA Drug Label
Symptomatic sarcoidosis The treatment option for pulmonary sarcoidosis is prednisone (PO), as it is indicated for symptomatic sarcoidosis 2.
- Key points:
- Prednisone is used to treat symptomatic sarcoidosis.
- The lowest possible dose of corticosteroids should be used to control the condition under treatment 2.
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 3
- Inhaled steroids, which can be used during the maintenance phase for treatment of pulmonary sarcoidosis 3, 4
- Alternative drugs, such as methotrexate, azathioprine, chlorambucil, and cyclophosphamide, which may be effective in sarcoidosis and have a steroid-sparing capacity 3, 4, 5, 6
- Antimalarials, such as chloroquine and hydroxychloroquine, which can be used for chronic skin lesions and hypercalcemia associated with sarcoidosis 3, 4
- Biologic agents, such as infliximab, which have proved effective in patients with refractory sarcoidosis 4, 5, 6
Corticosteroid Therapy
Corticosteroid therapy for pulmonary sarcoidosis involves six phases:
- Initial high doses to control inflammation
- Tapering to a maintenance dose
- Continuing to receive the maintenance dose
- Tapering off corticosteroid therapy
- Observation for relapse
- Treatment if relapse occurs 7
Treatment Approach
A step-wise approach to the management of pulmonary disease in sarcoidosis is proposed, which includes:
- Oral glucocorticoids as the standard first-line treatment
- Antimetabolites, such as methotrexate and azathioprine, as alternatives to steroids
- Anti-tumour necrosis factor (TNF) monoclonal antibodies for patients who cannot be treated with low-dose glucocorticoids and an antimetabolite
- New strategies, such as rituximab, for patients who do not respond to previous treatments 6