Corticosteroids in Sarcoidosis

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Key points

  • Corticosteroids are almost universally effective for the treatment of sarcoidosis. The treatment of sarcoidosis is indicated if the disease causes a dangerous health situation or significantly impairs the patient's quality of life.

  • Treatment should not be based on biomarkers of active granulomatous inflammation.

  • Pulmonary sarcoidosis can usually be adequately treated with modest doses of corticosteroids.

  • It is unusual for patients to be refractory to corticosteroid therapy. Alternative medications

Indications to treat sarcoidosis

There are 2 indications for the treatment of sarcoidosis: (1) the development of a dangerous health situation; and (2) significant worsening of quality of life. Table 1 lists several situations of danger resulting from sarcoidosis. Note that many of these relate to the development of fibrosis, which, unlike active granulomatous inflammation, is not corticosteroid responsive. Furthermore, most of the entities listed in Table 1 are rare manifestations of sarcoidosis. Therefore, the overwhelmingly

General approach to the treatment of sarcoidosis with corticosteroids

Corticosteroids are the initial drug of choice for the treatment of most forms of sarcoidosis because they are almost universally effective and a significant response is quickly observed, usually in a matter of a few weeks or less.10 Alternative antisarcoidosis therapies, including methotrexate11 antimalarials,12 and others,13 usually require several months to achieve a meaningful response. In addition, most alternative antisarcoidosis medications when used as monotherapy are effective as sole

Pulmonary Sarcoidosis

A Delphi study of sarcoidosis experts reached a consensus that corticosteroids are the drug of choice for the treatment of pulmonary sarcoidosis.23 The American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Diseases consensus statement recommends a daily prednisone equivalent of 20 to 40 mg for the initial treatment of pulmonary sarcoidosis.24 It is recommended that this dose be continued for at least 1 to 3 months and then tapered to a

Summary

Corticosteroids are the drug of choice for the treatment of sarcoidosis. Because of the toxicity of corticosteroids and other antisarcoidosis medications, therapy should only be considered when sarcoidosis causes a dangerous/potentially dangerous health situation or significantly affects the patient’s quality of life. Topical/local therapy should be considered whenever possible to minimize the risk of corticosteroid toxicity. When systemic therapy is required, patients should be aggressively

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