Materiały źródłowe

• #1 Sarcoidosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sarcoidosis/diagnosis-treatment/drc-20350363

  There’s no cure for sarcoidosis, but often sarcoidosis goes away on its own. You may not need treatment if you have no symptoms or only mild symptoms. If you need treatment, the type of treatment you have depends on how severe your symptoms are and what organs are affected. Treatment can lessen the body’s immune system response and inflammation. […] If your symptoms are severe or affected organs aren’t working properly, you may need medicines. These can include: […] Corticosteroids. These powerful medicines lessen inflammation. They’re usually the first treatment tried for sarcoidosis. The medicine can be given as pills or shots. In some cases, corticosteroids can be put directly on the affected area. […] Medicines that lower the immune system’s response. Medicines such as methotrexate (Trexall) and azathioprine (Azasan, Imuran) lessen inflammation by lowering the immune system’s response to a trigger.

• #2 Sarcoidosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/11863-sarcoidosis

  Treatment for sarcoidosis is usually to manage symptoms and prevent organ damage. Since granulomas are areas of inflammation caused by immune cells, sarcoidosis is usually treated with medications that modify or suppress your immune system. Treatment depends on where granulomas are in your body. […] Theres no specific cure for sarcoidosis, though it often goes away on its own. If symptoms arent bothersome or life-threatening, sarcoidosis sometimes doesnt need to be treated immediately. You and your healthcare provider will monitor your symptoms instead. […] Medications to treat sarcoidosis aim to reduce inflammation by modifying or suppressing your immune system. Some commonly used medications in sarcoidosis include: […] Corticosteroids, like prednisone and cortisone, are drugs that reduce inflammation in your body. These can either be pills that you swallow, an inhaler that you spray into your mouth or topical creams (applied directly to your skin or eyes).

• #3 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Sarcoidosis is a heterogeneous disease with various treatment indications. […] Regular patient follow-up is recommended for early recognition of active, ongoing organ-specific granulomatous inflammation to avoid progression to irreversible fibrosis. […] In this review, we elaborate on treatment indications and various anti-sarcoidosis regimens proven useful in clinical trials. […] The decision to treat with disease-modifying agents requires symptomatic, ongoing, and gradually worsening organ involvement (pulmonary or extrapulmonary) as well as certain asymptomatic but significant extrapulmonary manifestations, namely CS, neurosarcoidosis, posterior uveitis, and hypercalcemia. […] Thus, the goal of treatment is to prevent irreversible evolution of active granulomatous inflammation to fibrosis.

• #4 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Patients with advanced disease, pulmonary fibrosis, pulmonary hypertension, cardiac sarcoidosis, and neurosarcoidosis should be thoroughly identified and treated accordingly. […] Treatment of a patient with sarcoidosis should take into account not only physiologic impairment of the organ but also quality of life and patient-reported outcomes. […] Corticosteroids, the first-line treatment for acute and chronic disease, should be employed at the lowest affordable dose. […] To allow this, steroid-sparing agents, in particular methotrexate, are useful and effective. […] Infliximab, among anti-TNF agents, is effective in refractory pulmonary, cutaneous, and neurosarcoidosis. […] Fatigue and small fiber neuropathy impose significant burdens to patients, and efforts should be made to relieve them.

• #5 Sarcoidosis Treatment Options – Foundation for Sarcoidosis Research

  https://www.stopsarcoidosis.org/what-is-sarcoidosis/treatment-options/

  Medical treatment can be used to control symptoms, prevent complications, and improve outcomes in patients with persistent sarcoidosis. […] Many physicians will choose to treat when your quality of life is severely or when they believe there is danger of organ damage or death. […] In many cases of sarcoidosis, no treatment is necessary and sarcoidosis may go away without medical treatment. […] However, many other patients need consistent treatment for the ongoing effects of sarcoidosis. […] Sarcoidosis is often treated with the help of a multidisciplinary team of health care professionals. […] At specialized medical centers, these health care providers work as a team to develop a comprehensive treatment plan to control your symptoms and protect your overall health. […] Corticosteroids are the primary treatment for sarcoidosis. Treatment with corticosteroids relieves symptoms in most people within a few months.

• #6 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Treatment is directed at alleviating organ dysfunction, preventing irreversible scarring, and improving quality of life. […] Herein, we review the indications for treatment, pharmacotherapy, treatment duration, side effects, adjunct non-pharmacologic therapies, and outcomes for patients. […] A number of suggested treatment algorithms have been published, most of which are based upon initiation of corticosteroids in a symptomatic patient with abnormal function or imaging studies, followed by tapering of steroids over a minimum of 1 year. […] Importantly, outcomes of symptomatic response and toxicity profile can vary from patient to patient, emphasizing the need for a patient-centered approach. […] Therefore, management of patients with sarcoidosis often requires a three-pronged approach: treatment of symptomatic granulomatous inflammation, assessment of comorbid conditions, and tempering of immunosuppressive toxicities.

• #7 Sarcoidosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sarcoidosis/diagnosis-treatment/drc-20350363

  Hydroxychloroquine. Hydroxychloroquine (Plaquenil) may be helpful for skin lesions and high blood-calcium levels. […] Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medicines are commonly used to treat inflammation from rheumatoid arthritis. They also can be helpful in treating sarcoidosis that hasn’t responded to other treatments. […] Depending on your symptoms or complications, you may need other treatments. For example, you may have: […] Physical therapy to lessen tiredness and strengthen muscles. […] Pulmonary rehabilitation to help ease breathing and do more activities. […] An organ transplant may be an option for some people if sarcoidosis has severely damaged the lungs, heart or liver. […] Your healthcare professional monitors your symptoms and checks to see if you need treatment, how treatments are working and if you have complications. Ongoing monitoring may include tests based on your condition. […] Follow-up care is likely lifelong.

• #8 Treating and Managing Sarcoidosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/sarcoidosis/treating-and-managing

  If your sarcoidosis of the lungs progresses to pulmonary fibrosis, your healthcare provider may recommend additional treatments such as respiratory medications, oxygen therapy, pulmonary rehabilitation and in severe enough cases may consider you a candidate for a lung transplant. […] Managing sarcoidosis involves monitoring your symptoms closely to track the effectiveness of treatments. […] Medical treatment can be used to control symptoms, prevent complications and improve outcomes if you have persistent sarcoidosis. […] If your sarcoidosis goes into remission, meaning you no longer have any symptoms, your healthcare provider may choose to slowly stop your medications. […] Tell your healthcare provider if you have these feelings as treatment for anxiety and depression may make your sarcoidosis treatment more effective.

• #9 Sarcoidosis Treatment Options – Foundation for Sarcoidosis Research

  https://www.stopsarcoidosis.org/what-is-sarcoidosis/treatment-options/

  Medical treatment can be used to control symptoms, prevent complications, and improve outcomes in patients with persistent sarcoidosis. […] Many physicians will choose to treat when your quality of life is severely or when they believe there is danger of organ damage or death. […] In many cases of sarcoidosis, no treatment is necessary and sarcoidosis may go away without medical treatment. […] However, many other patients need consistent treatment for the ongoing effects of sarcoidosis. […] Sarcoidosis is often treated with the help of a multidisciplinary team of health care professionals. […] At specialized medical centers, these health care providers work as a team to develop a comprehensive treatment plan to control your symptoms and protect your overall health. […] Corticosteroids are the primary treatment for sarcoidosis. Treatment with corticosteroids relieves symptoms in most people within a few months.

• #10 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  The most efficient drug against sarcoidosis is undisputedly corticosteroids. […] Corticosteroids remain the mainstay first-line treatment of sarcoidosis. […] These effects are short-term, lasting for a period of 1 to 2 years, and fade after treatment withdrawal. […] When initiating corticosteroids in a patient with sarcoidosis, close follow-up every 3 months is mandatory. […] Based on existing literature, several principles apply when considering treating pulmonary sarcoidosis with corticosteroids: (1) acute disease and flares of chronic disease require the same prednisone doses, (2) the chronic maintenance dose should be the lowest possible, and (3) treatment with corticosteroids should be fairly prolonged to allow clearance of the etiologic antigen and adequate suppression of granulomatous reaction.

• #11 Sarcoidosis Treatment & Management: Medical Care, Surgical Care, Long-Term Monitoring

  https://emedicine.medscape.com/article/301914-treatment

  Most patients (75%) require only symptomatic therapy with NSAIDs. Approximately 10% of patients need treatment for extrapulmonary disease, while 15% of patients require treatment for persistent pulmonary disease. […] Corticosteroids are the mainstay of therapy. […] Generally, prednisone given daily and then tapered over a 6-month course is adequate for pulmonary disease. […] Some data suggest that corticosteroid use may be associated with increased relapse rates. However, data suggest early treatment of stage II sarcoidosis with oral prednisolone for 3 months followed by inhaled budesonide for 15 months improves 5-year pulmonary function and reduces the need for future steroid treatment. […] High-dose inhaled corticosteroids may be an option, but conclusive data are lacking. Inhaled corticosteroids, in particular, can be used in patients with endobronchial disease.

• #12 Sarcoidosis

  https://www.nhs.uk/conditions/sarcoidosis/

  There is currently no cure but symptoms can usually be managed with medicine. […] If treatment is recommended, steroid tablets are usually used. […] This helps relieve symptoms and prevent damage to affected organs by reducing inflammation and preventing scarring. […] However, steroid tablets can cause side effects such as weight gain and mood swings if taken in high doses. […] Other medicines may sometimes be used if steroids are not enough or there are concerns about side effects. In these cases, a medicine called an immunosuppressant might be recommended. This may help to improve your symptoms by reducing the activity of your immune system. […] Help is available for people with severe, persistent sarcoidosis.

• #13 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  The most efficient drug against sarcoidosis is undisputedly corticosteroids. […] Corticosteroids remain the mainstay first-line treatment of sarcoidosis. […] These effects are short-term, lasting for a period of 1 to 2 years, and fade after treatment withdrawal. […] When initiating corticosteroids in a patient with sarcoidosis, close follow-up every 3 months is mandatory. […] Based on existing literature, several principles apply when considering treating pulmonary sarcoidosis with corticosteroids: (1) acute disease and flares of chronic disease require the same prednisone doses, (2) the chronic maintenance dose should be the lowest possible, and (3) treatment with corticosteroids should be fairly prolonged to allow clearance of the etiologic antigen and adequate suppression of granulomatous reaction.

• #14

  https://link.springer.com/article/10.1007/s41030-021-00160-x

  Systemic glucocorticosteroids are the drug of first choice in the treatment of sarcoidosis. Once started, there is a 50% chance of long-term treatment. Prolonged use of prednisone at 10 mg/day or equivalent is not advised due to frequent severe side effects. […] Antimetabolites and biologics are useful additions to corticosteroids in refractory sarcoidosis or as steroid-sparing options. Methotrexate is the most commonly used antimetabolite. Infliximab is the biologic most commonly used in sarcoidosis management. […] Irrespective of treatment, the clinician needs to organize regular follow-ups to monitor remissions, flares, progression, complications, toxicity and relapses in order to promptly adjust treatment. […] GCs are the drug of first choice when systemic treatment is required. […] Most experts recommend oral prednisone 20-40 mg daily or equivalent in a single administration for treatment of naïve sarcoidosis patients.

• #15 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Corticosteroids are considered first-line treatment by consensus of sarcoidosis providers. […] Multiple uncontrolled studies have shown that corticosteroids suppress production of cytokines that contribute to persistent granuloma formation including TNF- and IFN-. […] However, only a small number of RCTs with corticosteroids have been performed. […] A starting dosage of 20-40 milligrams (mg) per day is generally recommended, although a few select patients with severe disease may be initiated on much higher doses in cases of severe neurosarcoidosis, refractory arrhythmias, ophthalmic disease threatening vision loss, or other severe organ damage. […] Methotrexate is the most frequently recommended second-line therapy, based on its well-established side effect profile and efficacy in autoimmune disease such as rheumatoid arthritis and psoriasis.

• #16 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  A standard protocol is prednisone 20 mg to 40 mg by mouth once a day, depending on symptoms and severity of findings. Alternate-day regimens may be used, eg, prednisone 40 mg by mouth once every other day. Although patients rarely require 40 mg/day, higher doses may be needed to reduce complications in severe neurologic and cardiac disease. […] Response usually occurs within 6 to 12 weeks, so symptoms, other disease-severity markers, and pulmonary function test results may be reassessed between 6 and 12 weeks. Chronic, insidious cases may respond more slowly. Corticosteroids are tapered to a maintenance dose (eg, prednisone 10 to 15 mg/day) after evidence of response and are continued for an additional 6 to 9 months if improvement occurs. […] The optimal duration of treatment is unknown. Premature taper can result in relapse. The medication is slowly stopped if response is absent or equivocal. Corticosteroids can ultimately be stopped in most patients, but because relapse occurs up to 50% of the time, monitoring should be repeated, usually every 3 to 6 months. Corticosteroid treatment should be resumed for recurrence of symptoms and signs. Because angiotensin-converting enzyme (ACE) production is suppressed with low doses of corticosteroids, serial serum ACE levels may be useful in assessing adherence with corticosteroid treatment in patients who have elevated ACE levels.

• #17 What is Sarcoidosis? – SarcoidosisUK

  https://www.sarcoidosisuk.org/information-hub/what-is-sarcoidosis/

  There is currently no known cure for sarcoidosis. […] Treatment is often necessary for patients whose sarcoidosis is causing severe symptoms or is preventing the affected organ(s) from functioning normally. Sometimes simple painkillers (paracetamol or non-steroidal anti-inflammatory such as ibuprofen) may help to ease the symptoms. […] The drugs used to treat sarcoidosis do so by reducing inflammation in the body. These are known as immunosuppressants. The most commonly used drugs are corticosteroids. These can be taken as a tablet (prednisolone) or given at a higher dose via a vein (methylprednisone). Treatment with corticosteroids is often required for at least 6 to 24 months. […] Sometimes corticosteroids may not be completely effective, or cause side effects. Other immunosuppressants may be used, either alone or in combination, to help reduce the steroid dose. These medications include Methotrexate, Azathioprine and Mycophenolate.

• #18 Sarcoidosis Treatment Options – Foundation for Sarcoidosis Research

  https://www.stopsarcoidosis.org/what-is-sarcoidosis/treatment-options/

  People with sarcoidosis may need to take corticosteroids for many months. […] Because sarcoidosis may be the result of an overreaction of the immune system, suppressing the immune system may ease symptoms and prevent further organ damage. […] When corticosteroids are not effective, your provider may talk with you about starting other medications, including methotrexate, azathioprine, and mycophenolate mofetil (CellCept). […] People with severe or advanced lung sarcoidosis may need oxygen therapy. […] In a few cases, lung transplantation the replacement of a diseased lung or lungs with a healthy donor lung is used to treat severe lung sarcoidosis.

• #19 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  A standard protocol is prednisone 20 mg to 40 mg by mouth once a day, depending on symptoms and severity of findings. Alternate-day regimens may be used, eg, prednisone 40 mg by mouth once every other day. Although patients rarely require 40 mg/day, higher doses may be needed to reduce complications in severe neurologic and cardiac disease. […] Response usually occurs within 6 to 12 weeks, so symptoms, other disease-severity markers, and pulmonary function test results may be reassessed between 6 and 12 weeks. Chronic, insidious cases may respond more slowly. Corticosteroids are tapered to a maintenance dose (eg, prednisone 10 to 15 mg/day) after evidence of response and are continued for an additional 6 to 9 months if improvement occurs. […] The optimal duration of treatment is unknown. Premature taper can result in relapse. The medication is slowly stopped if response is absent or equivocal. Corticosteroids can ultimately be stopped in most patients, but because relapse occurs up to 50% of the time, monitoring should be repeated, usually every 3 to 6 months. Corticosteroid treatment should be resumed for recurrence of symptoms and signs. Because angiotensin-converting enzyme (ACE) production is suppressed with low doses of corticosteroids, serial serum ACE levels may be useful in assessing adherence with corticosteroid treatment in patients who have elevated ACE levels.

• #20 Sarcoidosis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sarcoidosis

  Most patients get better within one to three years and may not need any medical treatment at all. […] Medical treatment is needed in serious or progressive cases. Steroid medication, such as prednisolone or cortisone, is the most common therapy. […] Initially, the dose of steroids may be high. The dose can often be reduced once the condition is under control. […] Once sarcoidosis appears to be improving, relapse is rare unless the medication is stopped. […] Never suddenly stop taking the medication. […] When resolved, sarcoidosis rarely returns.

• #21 Medication for Sarcoidosis | NYU Langone Health

  https://nyulangone.org/conditions/sarcoidosis/treatments/medication-for-sarcoidosis

  If sarcoidosis does not resolve on its own, your doctor may prescribe medication. […] The goal of treatment is to calm the overactive immune system, decrease inflammation, prevent damage to the lungs and other organs, and alleviate discomfort. […] Corticosteroids, also known as steroids, are the most commonly prescribed medications for sarcoidosis. […] If your symptoms dont improve with corticosteroids, your doctor may prescribe immunosuppressive medications, which may calm an overactive immune system and decrease inflammation. […] If sarcoidosis affects your skin, lungs, or brain, your doctor may prescribe medications that are commonly used to treat malaria. […] For severe symptoms of sarcoidosis, doctors may recommend advanced therapies such as biologic response modifiers, also known as biologics. […] Commonly prescribed medications include infliximab and adalimumab. […] Nonsteroidal anti-inflammatory drugs, or NSAIDs, are occasionally recommended for people with sarcoidosis to reduce inflammation and relieve the symptoms of arthritis and fever.

• #22 Sarcoidosis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/sarcoidosis

  Corticosteroids, usually prednisone, are particularly effective in reducing inflammation, and are typically the first drugs used in the treatment of sarcoidosis. […] In patients with mild symptoms, such as skin lesions, eye inflammation, or cough, topical steroid therapy with creams, eye-drops or inhalers may be sufficient to control the disease. […] When necessary, oral steroids are generally prescribed for six to twelve months. […] In most cases, a relatively high dose is prescribed at first, followed by a slow taper to the lowest effective dose. […] Symptoms, especially cough and shortness of breath, generally improve with steroid therapy. […] Relapses may occur after treatment with steroids has ended, but typically respond to repeated steroid treatment. […] Patients who improve and remain stable for more than year after the end of treatment have a low rate of relapse.

• #23 Sarcoidosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/11863-sarcoidosis

  Immunosuppressants help stop your immune system from causing organ damage and inflammation. Methotrexate is an immunosuppressant commonly used in sarcoidosis. […] Anti-tumor necrosis factor-alpha antibodies, like infliximab, target a specific chemical in your immune system to reduce inflammation. These drugs are given by a healthcare provider through an infusion into your vein. […] NSAIDS are medications that can give temporary relief of symptoms caused by inflammation. They arent usually prescribed for long-term use. […] Corticosteroids can put you at increased risk of getting sick with an infectious disease and can cause a number of side effects, including: […] For this reason, healthcare providers only recommend using medications to treat sarcoidosis if the benefits outweigh the risks.

• #24 Sarcoidosis

  https://www.nhs.uk/conditions/sarcoidosis/

  There is currently no cure but symptoms can usually be managed with medicine. […] If treatment is recommended, steroid tablets are usually used. […] This helps relieve symptoms and prevent damage to affected organs by reducing inflammation and preventing scarring. […] However, steroid tablets can cause side effects such as weight gain and mood swings if taken in high doses. […] Other medicines may sometimes be used if steroids are not enough or there are concerns about side effects. In these cases, a medicine called an immunosuppressant might be recommended. This may help to improve your symptoms by reducing the activity of your immune system. […] Help is available for people with severe, persistent sarcoidosis.

• #25 Sarcoidosis: Symptoms, Stages, Causes, and Treatment

  https://www.webmd.com/lung/arthritis-sarcoidosis

  There is no cure for sarcoidosis, but the disease often gets better on its own over time. Many people with sarcoidosis have mild symptoms and don’t need treatment. Treatment, when it is needed, can reduce symptoms and prevent organ damage. […] Your doctor may prescribe medications including: […] Corticosteroids. These drugs, such as prednisone and cortisone, reduce inflammation. You might get them as pills, inhaled sprays, or creams, depending on which parts of your body are involved. These are the most common treatments for sarcoidosis. Side effects of steroid pills can include mood changes, weight gain, increased blood pressure, and increased blood sugar. […] Immunosuppressants. These drugs tamp down your immune system, reducing inflammation and organ damage. Methotrexate is an immunosuppressant drug often used for sarcoidosis. You take these drugs as pills or shots. Side effects can include liver damage or blood problems.

• #26 Pulmonary Sarcoidosis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24653-pulmonary-sarcoidosis

  Not everyone with pulmonary sarcoidosis needs treatment. The condition often goes away on its own. […] But if you need treatment, your healthcare provider will probably recommend prednisone. This corticosteroid calms the immune system. But the medication can cause side effects if used for a long time, so its only appropriate for short-term treatment. […] For people who need treatment for pulmonary sarcoidosis but cant tolerate prednisone, healthcare providers may recommend: corticotropin, which helps your body produce natural steroid hormones; methotrexate, which can slow the immune system; tumor necrosis factor (TNF) inhibitors, which are often used against rheumatoid arthritis (for example, infliximab or adalimumab). […] Rare, severe cases of pulmonary sarcoidosis cause permanent lung damage, which may require: pulmonary rehabilitation, supplemental oxygen, surgery to replace a lung with a donor lung (lung transplant surgery).

• #27

  https://journals.lww.com/co-pulmonarymedicine/fulltext/2022/09000/hit_hard_and_early_versus_step_up_treatment_in.18.aspx

  For certain subpopulations of sarcoidosis patients, top-down therapy could be helpful. Severe pulmonary sarcoidosis, neurosarcoidosis, cardiac sarcoidosis and multiorgan sarcoidosis are phenotypes that may be most relevant for revised therapeutic algorithms. Precision medicine approaches and randomized trials will be necessary to confirm a role for top-down therapy in the routine management of sarcoidosis. […] Corticosteroids have been used for sarcoidosis for over 70 years. Even now, they remain the most commonly used medication for systemic management. Corticosteroids are highly effective, inexpensive, easily titrated, work quickly, are perceived to require less monitoring than other agents and are familiar to patients as well as prescribers. […] Although sarcoidosis experts typically advocate for earlier inclusion of steroid-sparing agents in treatment algorithms, in practice steroid-sparing agents are prescribed for much less than half of treatment-requiring patients.

• #28 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Addition of a second anti-inflammatory agent is deemed necessary when disease is severe and continued, when serial relapses occur, when corticosteroids are unable to be tapered below 10 to 15 mg of prednisone, when toxicity is significant, and when disease does not respond to corticosteroids. […] The most commonly studied second-line agent in sarcoidosis is antimetabolite methotrexate (MTX). […] MTX has exhibited a higher efficacy rate among second-line options managing disease control and steroids tapering in about 65% to 85% of patients with persistent pulmonary sarcoidosis. […] Azathioprine (AZA) is a second antimetabolite that has long been used for rheumatic and hematologic diseases and historically has been used in sarcoidosis. […] Leflunomide is a cytotoxic drug used in rheumatoid arthritis.

• #29 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other immunosuppressants […] Other immunosuppressants are used when […] Patients cannot tolerate prednisone […] Sarcoidosis is refractory to moderate to high doses of prednisone […] Prednisone dose cannot be tapered below 10 to 15 mg daily after 3 months […] Prior to adding other immunosuppressants, possible reasons for lack of clinical improvement, such as nonadherence, comorbid disease (eg, asthma, heart failure, anemia), pulmonary hypertension, and end-stage fibrosis should be considered. […] Methotrexate is the most commonly used immunosuppressant. Patients should be given a 6-month trial of methotrexate 10 to 15 mg/week. Before starting methotrexate, patients should be tested for hepatitis B virus and hepatitis C virus infection. […] Initially, methotrexate and corticosteroids are both given; over 6 to 8 weeks, the corticosteroid dose can be tapered and, in many cases, stopped. The maximal response to methotrexate, however, may take 6 to 12 months. In such cases, prednisone must be tapered more slowly. Serial blood counts and liver enzyme tests should be done every 2 to 4 weeks initially and then every 6 to 12 weeks once a stable dose is achieved. Folic acid (1 mg by mouth once a day) is recommended for patients treated with methotrexate to reduce the risk of adverse effects.

• #30 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Addition of a second anti-inflammatory agent is deemed necessary when disease is severe and continued, when serial relapses occur, when corticosteroids are unable to be tapered below 10 to 15 mg of prednisone, when toxicity is significant, and when disease does not respond to corticosteroids. […] The most commonly studied second-line agent in sarcoidosis is antimetabolite methotrexate (MTX). […] MTX has exhibited a higher efficacy rate among second-line options managing disease control and steroids tapering in about 65% to 85% of patients with persistent pulmonary sarcoidosis. […] Azathioprine (AZA) is a second antimetabolite that has long been used for rheumatic and hematologic diseases and historically has been used in sarcoidosis. […] Leflunomide is a cytotoxic drug used in rheumatoid arthritis.

• #31 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Corticosteroids are considered first-line treatment by consensus of sarcoidosis providers. […] Multiple uncontrolled studies have shown that corticosteroids suppress production of cytokines that contribute to persistent granuloma formation including TNF- and IFN-. […] However, only a small number of RCTs with corticosteroids have been performed. […] A starting dosage of 20-40 milligrams (mg) per day is generally recommended, although a few select patients with severe disease may be initiated on much higher doses in cases of severe neurosarcoidosis, refractory arrhythmias, ophthalmic disease threatening vision loss, or other severe organ damage. […] Methotrexate is the most frequently recommended second-line therapy, based on its well-established side effect profile and efficacy in autoimmune disease such as rheumatoid arthritis and psoriasis.

• #32 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Addition of a second anti-inflammatory agent is deemed necessary when disease is severe and continued, when serial relapses occur, when corticosteroids are unable to be tapered below 10 to 15 mg of prednisone, when toxicity is significant, and when disease does not respond to corticosteroids. […] The most commonly studied second-line agent in sarcoidosis is antimetabolite methotrexate (MTX). […] MTX has exhibited a higher efficacy rate among second-line options managing disease control and steroids tapering in about 65% to 85% of patients with persistent pulmonary sarcoidosis. […] Azathioprine (AZA) is a second antimetabolite that has long been used for rheumatic and hematologic diseases and historically has been used in sarcoidosis. […] Leflunomide is a cytotoxic drug used in rheumatoid arthritis.

• #33 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other immunosuppressants […] Other immunosuppressants are used when […] Patients cannot tolerate prednisone […] Sarcoidosis is refractory to moderate to high doses of prednisone […] Prednisone dose cannot be tapered below 10 to 15 mg daily after 3 months […] Prior to adding other immunosuppressants, possible reasons for lack of clinical improvement, such as nonadherence, comorbid disease (eg, asthma, heart failure, anemia), pulmonary hypertension, and end-stage fibrosis should be considered. […] Methotrexate is the most commonly used immunosuppressant. Patients should be given a 6-month trial of methotrexate 10 to 15 mg/week. Before starting methotrexate, patients should be tested for hepatitis B virus and hepatitis C virus infection. […] Initially, methotrexate and corticosteroids are both given; over 6 to 8 weeks, the corticosteroid dose can be tapered and, in many cases, stopped. The maximal response to methotrexate, however, may take 6 to 12 months. In such cases, prednisone must be tapered more slowly. Serial blood counts and liver enzyme tests should be done every 2 to 4 weeks initially and then every 6 to 12 weeks once a stable dose is achieved. Folic acid (1 mg by mouth once a day) is recommended for patients treated with methotrexate to reduce the risk of adverse effects.

• #34 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other immunosuppressants […] Other immunosuppressants are used when […] Patients cannot tolerate prednisone […] Sarcoidosis is refractory to moderate to high doses of prednisone […] Prednisone dose cannot be tapered below 10 to 15 mg daily after 3 months […] Prior to adding other immunosuppressants, possible reasons for lack of clinical improvement, such as nonadherence, comorbid disease (eg, asthma, heart failure, anemia), pulmonary hypertension, and end-stage fibrosis should be considered. […] Methotrexate is the most commonly used immunosuppressant. Patients should be given a 6-month trial of methotrexate 10 to 15 mg/week. Before starting methotrexate, patients should be tested for hepatitis B virus and hepatitis C virus infection. […] Initially, methotrexate and corticosteroids are both given; over 6 to 8 weeks, the corticosteroid dose can be tapered and, in many cases, stopped. The maximal response to methotrexate, however, may take 6 to 12 months. In such cases, prednisone must be tapered more slowly. Serial blood counts and liver enzyme tests should be done every 2 to 4 weeks initially and then every 6 to 12 weeks once a stable dose is achieved. Folic acid (1 mg by mouth once a day) is recommended for patients treated with methotrexate to reduce the risk of adverse effects.

• #35 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other immunosuppressants […] Other immunosuppressants are used when […] Patients cannot tolerate prednisone […] Sarcoidosis is refractory to moderate to high doses of prednisone […] Prednisone dose cannot be tapered below 10 to 15 mg daily after 3 months […] Prior to adding other immunosuppressants, possible reasons for lack of clinical improvement, such as nonadherence, comorbid disease (eg, asthma, heart failure, anemia), pulmonary hypertension, and end-stage fibrosis should be considered. […] Methotrexate is the most commonly used immunosuppressant. Patients should be given a 6-month trial of methotrexate 10 to 15 mg/week. Before starting methotrexate, patients should be tested for hepatitis B virus and hepatitis C virus infection. […] Initially, methotrexate and corticosteroids are both given; over 6 to 8 weeks, the corticosteroid dose can be tapered and, in many cases, stopped. The maximal response to methotrexate, however, may take 6 to 12 months. In such cases, prednisone must be tapered more slowly. Serial blood counts and liver enzyme tests should be done every 2 to 4 weeks initially and then every 6 to 12 weeks once a stable dose is achieved. Folic acid (1 mg by mouth once a day) is recommended for patients treated with methotrexate to reduce the risk of adverse effects.

• #36 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other immunosuppressants […] Other immunosuppressants are used when […] Patients cannot tolerate prednisone […] Sarcoidosis is refractory to moderate to high doses of prednisone […] Prednisone dose cannot be tapered below 10 to 15 mg daily after 3 months […] Prior to adding other immunosuppressants, possible reasons for lack of clinical improvement, such as nonadherence, comorbid disease (eg, asthma, heart failure, anemia), pulmonary hypertension, and end-stage fibrosis should be considered. […] Methotrexate is the most commonly used immunosuppressant. Patients should be given a 6-month trial of methotrexate 10 to 15 mg/week. Before starting methotrexate, patients should be tested for hepatitis B virus and hepatitis C virus infection. […] Initially, methotrexate and corticosteroids are both given; over 6 to 8 weeks, the corticosteroid dose can be tapered and, in many cases, stopped. The maximal response to methotrexate, however, may take 6 to 12 months. In such cases, prednisone must be tapered more slowly. Serial blood counts and liver enzyme tests should be done every 2 to 4 weeks initially and then every 6 to 12 weeks once a stable dose is achieved. Folic acid (1 mg by mouth once a day) is recommended for patients treated with methotrexate to reduce the risk of adverse effects.

• #37 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Addition of a second anti-inflammatory agent is deemed necessary when disease is severe and continued, when serial relapses occur, when corticosteroids are unable to be tapered below 10 to 15 mg of prednisone, when toxicity is significant, and when disease does not respond to corticosteroids. […] The most commonly studied second-line agent in sarcoidosis is antimetabolite methotrexate (MTX). […] MTX has exhibited a higher efficacy rate among second-line options managing disease control and steroids tapering in about 65% to 85% of patients with persistent pulmonary sarcoidosis. […] Azathioprine (AZA) is a second antimetabolite that has long been used for rheumatic and hematologic diseases and historically has been used in sarcoidosis. […] Leflunomide is a cytotoxic drug used in rheumatoid arthritis.

• #38

  https://link.springer.com/article/10.1007/s41030-021-00160-x

  Once treatment is started, it is usually continued for several months. […] Patients who do not respond to GCs, those who cannot be controlled over the long term with 10 mg/day prednisone, or those who develop intolerance to GC are candidates for treatment with alternative drugs. […] Antimetabolite immunosuppressants are the first addition (or alternative) to GC treatment. […] Methotrexate (MTX) is the additional (or alternative) drug of first choice with respect to GCs. […] Azathioprine (AZA) is the prodrug of 6-mercaptopurine that halts the purine pathway and proliferating cells. […] Anti-TNF- agents are the biologic of first choice. […] Among anti-TNF- agents, intravenous IFX is the drug of first choice in sarcoidosis. […] The beneficial effects of adrenocorticotropic hormone (ACTH) in sarcoidosis have been known for many years, as it was initially approved by the Food Drug Administration (FDA) for the treatment of sarcoidosis in 1952.

• #39 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  The drug may also have other anti-inflammatory effects on T cells, suppressing formation of contributing cytokines by these cells via the adenosine a2a receptors. […] Similarly, leflunomide, a dihydroorotase inhibitor that inhibits dividing lymphocytes, is often used as an alternative (or even additionally, in some cases) to methotrexate in sarcoidosis. […] Azathioprine, an inhibitor of purine metabolism, can also be considered as a steroid-sparing agent in patients with sarcoidosis, with similar efficacy compared to methotrexate to improve FVC and diffusing capacity (DLCO), and to taper corticosteroids. […] Mycophenolate mofetil (MMF) is another second-line option that acts by inhibiting purine nucleotide synthesis specifically in lymphocytes and decreases production of autoantibodies by B cells.

• #40 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Addition of a second anti-inflammatory agent is deemed necessary when disease is severe and continued, when serial relapses occur, when corticosteroids are unable to be tapered below 10 to 15 mg of prednisone, when toxicity is significant, and when disease does not respond to corticosteroids. […] The most commonly studied second-line agent in sarcoidosis is antimetabolite methotrexate (MTX). […] MTX has exhibited a higher efficacy rate among second-line options managing disease control and steroids tapering in about 65% to 85% of patients with persistent pulmonary sarcoidosis. […] Azathioprine (AZA) is a second antimetabolite that has long been used for rheumatic and hematologic diseases and historically has been used in sarcoidosis. […] Leflunomide is a cytotoxic drug used in rheumatoid arthritis.

• #41 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  The drug may also have other anti-inflammatory effects on T cells, suppressing formation of contributing cytokines by these cells via the adenosine a2a receptors. […] Similarly, leflunomide, a dihydroorotase inhibitor that inhibits dividing lymphocytes, is often used as an alternative (or even additionally, in some cases) to methotrexate in sarcoidosis. […] Azathioprine, an inhibitor of purine metabolism, can also be considered as a steroid-sparing agent in patients with sarcoidosis, with similar efficacy compared to methotrexate to improve FVC and diffusing capacity (DLCO), and to taper corticosteroids. […] Mycophenolate mofetil (MMF) is another second-line option that acts by inhibiting purine nucleotide synthesis specifically in lymphocytes and decreases production of autoantibodies by B cells.

• #42

  https://link.springer.com/article/10.1007/s41030-021-00160-x

  Once treatment is started, it is usually continued for several months. […] Patients who do not respond to GCs, those who cannot be controlled over the long term with 10 mg/day prednisone, or those who develop intolerance to GC are candidates for treatment with alternative drugs. […] Antimetabolite immunosuppressants are the first addition (or alternative) to GC treatment. […] Methotrexate (MTX) is the additional (or alternative) drug of first choice with respect to GCs. […] Azathioprine (AZA) is the prodrug of 6-mercaptopurine that halts the purine pathway and proliferating cells. […] Anti-TNF- agents are the biologic of first choice. […] Among anti-TNF- agents, intravenous IFX is the drug of first choice in sarcoidosis. […] The beneficial effects of adrenocorticotropic hormone (ACTH) in sarcoidosis have been known for many years, as it was initially approved by the Food Drug Administration (FDA) for the treatment of sarcoidosis in 1952.

• #43 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  The drug may also have other anti-inflammatory effects on T cells, suppressing formation of contributing cytokines by these cells via the adenosine a2a receptors. […] Similarly, leflunomide, a dihydroorotase inhibitor that inhibits dividing lymphocytes, is often used as an alternative (or even additionally, in some cases) to methotrexate in sarcoidosis. […] Azathioprine, an inhibitor of purine metabolism, can also be considered as a steroid-sparing agent in patients with sarcoidosis, with similar efficacy compared to methotrexate to improve FVC and diffusing capacity (DLCO), and to taper corticosteroids. […] Mycophenolate mofetil (MMF) is another second-line option that acts by inhibiting purine nucleotide synthesis specifically in lymphocytes and decreases production of autoantibodies by B cells.

• #44 Clinical Pharmacology in Sarcoidosis: How to Use and Monitor Sarcoidosis Medications

  https://www.mdpi.com/2077-0383/13/5/1250

  Leflunomide (LEF) is regarded as a second-line agent for sarcoidosis. LEF is specifically recommended as a second-line agent for pulmonary and cardiac sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines. […] Azathioprine (AZA) is regarded as a second-line agent for sarcoidosis. AZA is specifically recommended as a second-line agent for pulmonary, cardiac, and neurologic sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines. […] Mycophenolate is regarded as a second-line agent for sarcoidosis. Mycophenolate is specifically recommended as a second-line agent for pulmonary, cardiac, and neurologic sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines.

• #45 Clinical Pharmacology in Sarcoidosis: How to Use and Monitor Sarcoidosis Medications

  https://www.mdpi.com/2077-0383/13/5/1250

  Leflunomide (LEF) is regarded as a second-line agent for sarcoidosis. LEF is specifically recommended as a second-line agent for pulmonary and cardiac sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines. […] Azathioprine (AZA) is regarded as a second-line agent for sarcoidosis. AZA is specifically recommended as a second-line agent for pulmonary, cardiac, and neurologic sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines. […] Mycophenolate is regarded as a second-line agent for sarcoidosis. Mycophenolate is specifically recommended as a second-line agent for pulmonary, cardiac, and neurologic sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines.

• #46 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Hydroxychloroquine and hydroxychloroquine (HCQ) are antimalaria drugs used to treat sarcoidosis. […] Mycophenolate mofetil (MMF) is a powerful inhibitor of lymphocyte proliferation, used to prevent allograft rejection after transplant. […] Anti-tumor necrosis factor- (anti-TNF-) agents are considered effective third-line drugs in sarcoidosis (especially with refractory pulmonary disease and neurosarcoidosis) by blocking TNF-, a significant cytokine in granulomatous inflammation. […] Treatment of CS is two-fold. […] Studies have shown long-term benefit of early initiation of immunosuppressives in CS. […] Corticosteroids in particular have shown survival and functional benefit, albeit not in randomized trials; lower doses of prednisone (no more than 30 mg) are not inferior to higher doses and are preferred.

• #47 Sarcoidosis Treatment & Management: Medical Care, Surgical Care, Long-Term Monitoring

  https://emedicine.medscape.com/article/301914-treatment

  Chloroquine and hydroxychloroquine are antimalarial drugs with immunomodulating properties, which have been used for cutaneous lesions, hypercalcemia, neurological sarcoidosis, and bone lesions. […] Cyclophosphamide has been rarely used with modest success as a steroid-sparing treatment in patients with refractory sarcoidosis. […] Azathioprine is another second-line therapy, which is best used as a steroid-sparing agent rather than as a single-drug treatment for sarcoidosis. […] Chlorambucil is an alkylating agent that may be beneficial in patients with progressive disease unresponsive to corticosteroids. […] Infliximab and thalidomide have also been used for refractory sarcoidosis, particularly for cutaneous disease. […] For pulmonary disease, asymptomatic pulmonary function testing and/or chest radiography abnormalities are not an indication for treatment.

• #48 What is Sarcoidosis? Causes, Symptoms, and More

  https://www.healthline.com/health/sarcoidosis

  Antimalarial medications: Medications like hydroxychloroquine (Plaquenil) may be helpful for sarcoidosis symptoms that affect the skin and joints. […] Immunotherapy: These medications help stop an overactive immune system. They have significant side effects, so theyre typically reserved for people whose bodies do not tolerate other medications. Examples include rituximab (Rituxan), infliximab (Remicade), and golimumab (Simponi). […] Corticotropin: Doctors may recommend this injected medication to encourage the body to produce natural steroid hormones. […] The length of any treatment will vary. Some people take medication for 1 to 2 years. Other people may need to take medication for much longer. […] A doctor may also recommend additional medications to help manage your symptoms, such as skin infections or joint pain. […] Treatment typically involves medications to suppress the immune system. While there is no cure for sarcoidosis, some people may experience a complete resolution of the condition. But, for some people, it can develop into a long lasting condition.

• #49 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other nonbiologic immunosuppressants include azathioprine, mycophenolate, cyclophosphamide, leflunomide, and hydroxychloroquine. Hydroxychloroquine is usually effective for treating hypercalcemia, arthralgia, skin sarcoidosis, or enlarged uncomfortable or disfiguring peripheral lymph nodes. Ophthalmologic evaluation should be done before hydroxychloroquine is started and then every 12 months during treatment to monitor for its ocular toxicity. […] Relapse is common after stopping an immunosuppressant. […] Tumor necrosis factor inhibitors […] Infliximab is usually used to treat refractory sarcoidosis and to treat patients who are intolerant to both corticosteroid and the above-mentioned nonbiologic immunosuppressants. Before beginning therapy, patients should have a purified protein derivative (PPD) or interferon gamma release assay to screen for latent tuberculosis. Infliximab is given intravenously and it may take up to 3 to 6 months for maximal response. Infliximab is usually combined with low-dose methotrexate or azathioprine to prevent antibody formation against it.

• #50 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Hydroxychloroquine and hydroxychloroquine (HCQ) are antimalaria drugs used to treat sarcoidosis. […] Mycophenolate mofetil (MMF) is a powerful inhibitor of lymphocyte proliferation, used to prevent allograft rejection after transplant. […] Anti-tumor necrosis factor- (anti-TNF-) agents are considered effective third-line drugs in sarcoidosis (especially with refractory pulmonary disease and neurosarcoidosis) by blocking TNF-, a significant cytokine in granulomatous inflammation. […] Treatment of CS is two-fold. […] Studies have shown long-term benefit of early initiation of immunosuppressives in CS. […] Corticosteroids in particular have shown survival and functional benefit, albeit not in randomized trials; lower doses of prednisone (no more than 30 mg) are not inferior to higher doses and are preferred.

• #51 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Hydroxychloroquine has been particularly useful in cutaneous disease, hypercalcemia, and in some cases of neurosarcoidosis. […] The use of TNF antagonists is supported by numerous compelling case reports and series in refractory sarcoidosis. […] Currently, infliximab is the most well-studied third-line agent and dosage recommendations are 35 mg/kg with maintenance therapy every 48 weeks after initial loading. […] The advent of biosimilars has provided another, potentially less expensive, option for clinicians who desire an anti-TNF therapy. […] Rituximab, a chimeric monoclonal antibody against CD20+ B cells that reduce the mature circulating population, has been investigated in small studies. […] Antifibrotics, now approved for treatment of idiopathic pulmonary fibrosis and progressive fibrotic interstitial lung diseases (ILDs), are also an enticing possibility for fibrotic sarcoidosis.

• #52 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Hydroxychloroquine has been particularly useful in cutaneous disease, hypercalcemia, and in some cases of neurosarcoidosis. […] The use of TNF antagonists is supported by numerous compelling case reports and series in refractory sarcoidosis. […] Currently, infliximab is the most well-studied third-line agent and dosage recommendations are 35 mg/kg with maintenance therapy every 48 weeks after initial loading. […] The advent of biosimilars has provided another, potentially less expensive, option for clinicians who desire an anti-TNF therapy. […] Rituximab, a chimeric monoclonal antibody against CD20+ B cells that reduce the mature circulating population, has been investigated in small studies. […] Antifibrotics, now approved for treatment of idiopathic pulmonary fibrosis and progressive fibrotic interstitial lung diseases (ILDs), are also an enticing possibility for fibrotic sarcoidosis.

• #53 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Patients with advanced disease, pulmonary fibrosis, pulmonary hypertension, cardiac sarcoidosis, and neurosarcoidosis should be thoroughly identified and treated accordingly. […] Treatment of a patient with sarcoidosis should take into account not only physiologic impairment of the organ but also quality of life and patient-reported outcomes. […] Corticosteroids, the first-line treatment for acute and chronic disease, should be employed at the lowest affordable dose. […] To allow this, steroid-sparing agents, in particular methotrexate, are useful and effective. […] Infliximab, among anti-TNF agents, is effective in refractory pulmonary, cutaneous, and neurosarcoidosis. […] Fatigue and small fiber neuropathy impose significant burdens to patients, and efforts should be made to relieve them.

• #54 State-of-the-Art Treatments for Sarcoidosis | Methodist DeBakey Cardiovascular J

  https://journal.houstonmethodist.org/articles/10.14797/mdcvj.1068

  To allow this, steroid-sparing agents, in particular methotrexate, are useful and effective. […] Infliximab, among anti-TNF agents, is effective in refractory pulmonary, cutaneous, and neurosarcoidosis. […] Advanced sarcoidosis refers to high mortality disease manifestations (pulmonary fibrosis, pulmonary hypertension, cardiac sarcoidosis, and neurosarcoidosis) and necessitates treatment.

• #55 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Hydroxychloroquine has been particularly useful in cutaneous disease, hypercalcemia, and in some cases of neurosarcoidosis. […] The use of TNF antagonists is supported by numerous compelling case reports and series in refractory sarcoidosis. […] Currently, infliximab is the most well-studied third-line agent and dosage recommendations are 35 mg/kg with maintenance therapy every 48 weeks after initial loading. […] The advent of biosimilars has provided another, potentially less expensive, option for clinicians who desire an anti-TNF therapy. […] Rituximab, a chimeric monoclonal antibody against CD20+ B cells that reduce the mature circulating population, has been investigated in small studies. […] Antifibrotics, now approved for treatment of idiopathic pulmonary fibrosis and progressive fibrotic interstitial lung diseases (ILDs), are also an enticing possibility for fibrotic sarcoidosis.

• #56 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other nonbiologic immunosuppressants include azathioprine, mycophenolate, cyclophosphamide, leflunomide, and hydroxychloroquine. Hydroxychloroquine is usually effective for treating hypercalcemia, arthralgia, skin sarcoidosis, or enlarged uncomfortable or disfiguring peripheral lymph nodes. Ophthalmologic evaluation should be done before hydroxychloroquine is started and then every 12 months during treatment to monitor for its ocular toxicity. […] Relapse is common after stopping an immunosuppressant. […] Tumor necrosis factor inhibitors […] Infliximab is usually used to treat refractory sarcoidosis and to treat patients who are intolerant to both corticosteroid and the above-mentioned nonbiologic immunosuppressants. Before beginning therapy, patients should have a purified protein derivative (PPD) or interferon gamma release assay to screen for latent tuberculosis. Infliximab is given intravenously and it may take up to 3 to 6 months for maximal response. Infliximab is usually combined with low-dose methotrexate or azathioprine to prevent antibody formation against it.

• #57 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Other nonbiologic immunosuppressants include azathioprine, mycophenolate, cyclophosphamide, leflunomide, and hydroxychloroquine. Hydroxychloroquine is usually effective for treating hypercalcemia, arthralgia, skin sarcoidosis, or enlarged uncomfortable or disfiguring peripheral lymph nodes. Ophthalmologic evaluation should be done before hydroxychloroquine is started and then every 12 months during treatment to monitor for its ocular toxicity. […] Relapse is common after stopping an immunosuppressant. […] Tumor necrosis factor inhibitors […] Infliximab is usually used to treat refractory sarcoidosis and to treat patients who are intolerant to both corticosteroid and the above-mentioned nonbiologic immunosuppressants. Before beginning therapy, patients should have a purified protein derivative (PPD) or interferon gamma release assay to screen for latent tuberculosis. Infliximab is given intravenously and it may take up to 3 to 6 months for maximal response. Infliximab is usually combined with low-dose methotrexate or azathioprine to prevent antibody formation against it.

• #58 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Adalimumab can be considered for patients with ocular or cutaneous sarcoidosis and in patients who have been treated successfully with infliximab but have developed antibodies or infusion reactions. […] Other treatment considerations […] Patients who have heart block or ventricular arrhythmias due to cardiac involvement should receive an implantable cardiac defibrillator and pacemaker in addition to pharmacotherapy. […] Tetracycline antibiotics such as doxycycline or minocycline can be tried for cutaneous sarcoidosis. […] No available medications have consistently prevented pulmonary fibrosis. […] Treatment of sarcoidosis-associated pulmonary arterial hypertension (SPAH) is supportive with diuresis and supplemental oxygen. The role of pulmonary vasodilators in treating SPAH has not been well established; a few small studies have suggested efficacy, but larger studies are needed to confirm it.

• #59 Medication for Sarcoidosis | NYU Langone Health

  https://nyulangone.org/conditions/sarcoidosis/treatments/medication-for-sarcoidosis

  If sarcoidosis does not resolve on its own, your doctor may prescribe medication. […] The goal of treatment is to calm the overactive immune system, decrease inflammation, prevent damage to the lungs and other organs, and alleviate discomfort. […] Corticosteroids, also known as steroids, are the most commonly prescribed medications for sarcoidosis. […] If your symptoms dont improve with corticosteroids, your doctor may prescribe immunosuppressive medications, which may calm an overactive immune system and decrease inflammation. […] If sarcoidosis affects your skin, lungs, or brain, your doctor may prescribe medications that are commonly used to treat malaria. […] For severe symptoms of sarcoidosis, doctors may recommend advanced therapies such as biologic response modifiers, also known as biologics. […] Commonly prescribed medications include infliximab and adalimumab. […] Nonsteroidal anti-inflammatory drugs, or NSAIDs, are occasionally recommended for people with sarcoidosis to reduce inflammation and relieve the symptoms of arthritis and fever.

• #60 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Hydroxychloroquine has been particularly useful in cutaneous disease, hypercalcemia, and in some cases of neurosarcoidosis. […] The use of TNF antagonists is supported by numerous compelling case reports and series in refractory sarcoidosis. […] Currently, infliximab is the most well-studied third-line agent and dosage recommendations are 35 mg/kg with maintenance therapy every 48 weeks after initial loading. […] The advent of biosimilars has provided another, potentially less expensive, option for clinicians who desire an anti-TNF therapy. […] Rituximab, a chimeric monoclonal antibody against CD20+ B cells that reduce the mature circulating population, has been investigated in small studies. […] Antifibrotics, now approved for treatment of idiopathic pulmonary fibrosis and progressive fibrotic interstitial lung diseases (ILDs), are also an enticing possibility for fibrotic sarcoidosis.

• #61 Clinical Pharmacology in Sarcoidosis: How to Use and Monitor Sarcoidosis Medications

  https://www.mdpi.com/2077-0383/13/5/1250

  Hydroxychloroquine (HCQ) is regarded as a second-line agent for sarcoidosis. HCQ is specifically recommended as a second-line agent for pulmonary, skin, and neurologic sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines. […] IFX and ADA are regarded as third-line agents for sarcoidosis. Both IFX and ADA are specifically recommended as a third-line agent for pulmonary, skin, cardiac, and neurologic sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines. […] RTX is regarded as a fourth-line agent/salvage therapy for sarcoidosis. RTX is specifically recommended as a fourth-line agent for pulmonary sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines. […] RCI is regarded as a fourth-line agent or salvage therapy for sarcoidosis. RCI is specifically recommended as a fourth-line agent for pulmonary sarcoidosis in the European Respiratory Society (ERS) Clinical Practice Sarcoidosis Treatment Guidelines.

• #62 Treating sarcoidosis with JAK inhibitor shows promise in clinical trial | Yale News

  https://news.yale.edu/2022/06/06/treating-sarcoidosis-jak-inhibitor-shows-promise-clinical-trial

  Every patient in a Yale clinical trial of a new treatment for the disfiguring disease sarcoidosis saw improvement to their skin. […] The only approved therapy for sarcoidosis is the steroid prednisone, which carries significant side effects. […] For the new clinical trial, a Yale team led by Drs. William Damsky and Brett King treated 10 patients with tofacitinib, a Janus kinase (JAK) inhibitor normally used to treat rheumatoid arthritis and other autoimmune diseases. […] Sarcoidosis can be a devastating disease and is often difficult to treat. We were excited to find that this treatment approach really appears to hold great promise, said Damsky, an assistant professor of dermatology and dermatopathology at Yale Medical School and first author of a new study about the clinical trial in the journal Nature Communications.

• #63 Treating sarcoidosis with JAK inhibitor shows promise in clinical trial | Yale News

  https://news.yale.edu/2022/06/06/treating-sarcoidosis-jak-inhibitor-shows-promise-clinical-trial

  In the clinical trial, patients received tofacitinib for six months. All patients experienced significant improvement in their skin sarcoidosis with six patients seeing a complete recovery. […] Five of the nine patients with affected internal organs saw improvement in those organs, as well. Internal organ sarcoidosis was measured by using positron emission tomography (PET) scans; the five improving patients in the clinical trial experienced a reduction in internal organ disease of more than 50%. […] The researchers said tofacitinib proved effective because it suppressed interferon-gamma, an immune system protein that is a key driver of sarcoidosis.

• #64 Treating sarcoidosis with JAK inhibitor shows promise in clinical trial | Yale News

  https://news.yale.edu/2022/06/06/treating-sarcoidosis-jak-inhibitor-shows-promise-clinical-trial

  In the clinical trial, patients received tofacitinib for six months. All patients experienced significant improvement in their skin sarcoidosis with six patients seeing a complete recovery. […] Five of the nine patients with affected internal organs saw improvement in those organs, as well. Internal organ sarcoidosis was measured by using positron emission tomography (PET) scans; the five improving patients in the clinical trial experienced a reduction in internal organ disease of more than 50%. […] The researchers said tofacitinib proved effective because it suppressed interferon-gamma, an immune system protein that is a key driver of sarcoidosis.

• #65 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240123/Scientists-identify-a-new-approach-to-treating-sarcoidosis.aspx

  A research team led by Georg Stary (Medical University of Vienna and CeMM) has identified a new approach to treating the inflammatory disease sarcoidosis. In a clinical study, the inhibition of a specific signaling pathway showed clear success in the treatment of granulomas in the skin. This opens up new therapeutic paths for sarcoidosis and similar inflammatory diseases. […] In their study, the researchers from MedUni Vienna and CeMM (Research Center for Molecular Medicine of the Austrian Academy of Sciences) focused their attention on possible new therapeutic approaches for sarcoidosis. They chose the mTOR (mechanistic target of rapamycin) signaling pathway, which is known to regulate metabolism and growth in many cell types, as mTOR activation was observed in granulomas of patients from different tissues.

• #66 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240123/Scientists-identify-a-new-approach-to-treating-sarcoidosis.aspx

  The researchers used the mTOR inhibitor sirolimus, which was first approved in 1999 to prevent organ rejection after kidney transplants. It had already shown promise in preclinical models of sarcoidosis. […] Sirolimus was first administered topically (as a cream) and then systemically (as an oral solution) to test its effect on the skin granulomas. […] In contrast, systemic treatment was successful in 7 out of 10 patients, who completed the study, and some even experienced complete regression after four months of treatment and no recurrence up to two years later. […] We suspect that, unlike broad-spectrum immunosuppressants, mTOR inhibition targets both immune and non-immune cells in granulomas, which prevents a recurrence of tissue granulomas. […] The clinical study also suggests an effect of systemic treatment on granulomas in other vital organs, although it is difficult to draw concrete conclusions due to the small number of patients.

• #67 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240123/Scientists-identify-a-new-approach-to-treating-sarcoidosis.aspx

  The researchers used the mTOR inhibitor sirolimus, which was first approved in 1999 to prevent organ rejection after kidney transplants. It had already shown promise in preclinical models of sarcoidosis. […] Sirolimus was first administered topically (as a cream) and then systemically (as an oral solution) to test its effect on the skin granulomas. […] In contrast, systemic treatment was successful in 7 out of 10 patients, who completed the study, and some even experienced complete regression after four months of treatment and no recurrence up to two years later. […] We suspect that, unlike broad-spectrum immunosuppressants, mTOR inhibition targets both immune and non-immune cells in granulomas, which prevents a recurrence of tissue granulomas. […] The clinical study also suggests an effect of systemic treatment on granulomas in other vital organs, although it is difficult to draw concrete conclusions due to the small number of patients.

• #68 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240123/Scientists-identify-a-new-approach-to-treating-sarcoidosis.aspx

  The researchers are now planning a multi-center clinical trial with more patients to confirm the skin results and further test the drug’s efficacy, especially in lung involvement, which is present in 90 percent of sarcoidosis sufferers. […] In future work, the researchers want to investigate the significance of mTOR and other signaling pathways in other non-infectious granulomatous skin diseases such as necrobiosis lipoidica, which is often associated with diabetes. Stary hopes that their research will lead to further targeted therapies for these neglected diseases.

• #69 Sarcoidosis Treatment & Management: Medical Care, Surgical Care, Long-Term Monitoring

  https://emedicine.medscape.com/article/301914-treatment

  Most patients (75%) require only symptomatic therapy with NSAIDs. Approximately 10% of patients need treatment for extrapulmonary disease, while 15% of patients require treatment for persistent pulmonary disease. […] Corticosteroids are the mainstay of therapy. […] Generally, prednisone given daily and then tapered over a 6-month course is adequate for pulmonary disease. […] Some data suggest that corticosteroid use may be associated with increased relapse rates. However, data suggest early treatment of stage II sarcoidosis with oral prednisolone for 3 months followed by inhaled budesonide for 15 months improves 5-year pulmonary function and reduces the need for future steroid treatment. […] High-dose inhaled corticosteroids may be an option, but conclusive data are lacking. Inhaled corticosteroids, in particular, can be used in patients with endobronchial disease.

• #70 Sarcoidosis: Symptoms, Stages, Causes, and Treatment

  https://www.webmd.com/lung/arthritis-sarcoidosis

  Anti-tumor necrosis factor-alpha antibodies (anti-TNF-alpha antibodies). These drugs target a specific immune system chemical. You get them through an intravenous (IV) treatment, meaning the drugs go through a needle into a vein. Side effects can include an increased risk of serious infection. […] Anti-malarial medications. Drugs commonly used to treat malaria, such as hydroxychloroquine and chloroquine, also can reduce inflammation and are sometimes prescribed for sarcoidosis. You take them in pill form. Side effects can include serious skin rashes and vision changes. […] In some cases, your doctor might recommend you take nonsteroidal anti-inflammatory drugs (NSAIDS) that you can buy without a prescription. These are drugs like aspirin, ibuprofen, and naproxen that can temporarily relieve symptoms like joint pain and fever. Long-term use can lead to heartburn, vomiting, and stomach bleeding, so you should always talk to your doctor before you start any regular NSAID use.

• #71 Sarcoidosis: Symptoms, Stages, Causes, and Treatment

  https://www.webmd.com/lung/arthritis-sarcoidosis

  Anti-tumor necrosis factor-alpha antibodies (anti-TNF-alpha antibodies). These drugs target a specific immune system chemical. You get them through an intravenous (IV) treatment, meaning the drugs go through a needle into a vein. Side effects can include an increased risk of serious infection. […] Anti-malarial medications. Drugs commonly used to treat malaria, such as hydroxychloroquine and chloroquine, also can reduce inflammation and are sometimes prescribed for sarcoidosis. You take them in pill form. Side effects can include serious skin rashes and vision changes. […] In some cases, your doctor might recommend you take nonsteroidal anti-inflammatory drugs (NSAIDS) that you can buy without a prescription. These are drugs like aspirin, ibuprofen, and naproxen that can temporarily relieve symptoms like joint pain and fever. Long-term use can lead to heartburn, vomiting, and stomach bleeding, so you should always talk to your doctor before you start any regular NSAID use.

• #72

  https://link.springer.com/article/10.1007/s41030-021-00160-x

  Monotherapy with antimicrobials is not effective for sarcoidosis. However, an 8-week open-label trial has shown that concomitant use of levofloxacin, ethambutol, azithromycin and rifampin, also known as CLEAR therapy, may improve quality of life and FVC in some pulmonary sarcoidosis patients. […] The treatment of cardiac sarcoidosis requires particular attention, as it may manifest in very severe forms or even as sudden death. […] Standard-dose GCs are the pharmacological treatment of first choice for CS. […] GC-sparing (or adjunctive) treatments include MTX, AZA, MMF and cyclophosphamide. […] The one-size-fits-all approach is not ideal for sarcoidosis. As knowledge increases, personalization of therapy (and hopefully more effective and safer treatment) will be an aim.

• #73 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Adalimumab can be considered for patients with ocular or cutaneous sarcoidosis and in patients who have been treated successfully with infliximab but have developed antibodies or infusion reactions. […] Other treatment considerations […] Patients who have heart block or ventricular arrhythmias due to cardiac involvement should receive an implantable cardiac defibrillator and pacemaker in addition to pharmacotherapy. […] Tetracycline antibiotics such as doxycycline or minocycline can be tried for cutaneous sarcoidosis. […] No available medications have consistently prevented pulmonary fibrosis. […] Treatment of sarcoidosis-associated pulmonary arterial hypertension (SPAH) is supportive with diuresis and supplemental oxygen. The role of pulmonary vasodilators in treating SPAH has not been well established; a few small studies have suggested efficacy, but larger studies are needed to confirm it.

• #74 Sarcoidosis Treatment | National Jewish Health

  https://www.nationaljewish.org/conditions/sarcoidosis/sarcoidosis-overview/treatment

  What is the Treatment for Sarcoidosis? Up to one-half of the people diagnosed with sarcoidosis improve without treatment. Those who do not improve are often placed on medicine to reduce inflammation. Many people will recover, but some will get worse despite treatment. The goals of treatment are to: Maintain good organ function […] Lessen symptoms […] Prevent organ damage […] Several medicines are used to treat sarcoidosis. Corticosteroids, which work to reduce inflammation, are the main treatment. Generally, prednisone (a tablet) is given daily or every other day, depending on the symptoms. Prednisone can decrease symptoms, improve lung function, reduce granuloma formation, and possibly lessen scarring of the lungs. Prednisone can be associated with a number of side effects. Because of this, your doctor will carefully monitor you. Prednisone is not the medication of choice for long-term management of sarcoidosis. For long-term management of sarcoidosis, steroid-sparing agents are often used. Methotrexate is an anti-inflammatory medicine. It is often used as a second-line medicine. It may be used with corticosteroids or after stopping corticosteroids. Other medicines are used if corticosteroids and methotrexate are not effective. These other medicines are not used often, since their effect on sarcoidosis is not as well understood. They also can have side effects. Oxygen therapy may be an important part of a treatment plan for people with severe sarcoidosis. It can help reduce heart and lung long-term problems caused by low oxygen levels. For people who develop chronic, progressive sarcoidosis, pulmonary rehabilitation also may be helpful. This includes exercise, healthy eating and education. Because treatment is so important, a person can improve the outcome of sarcoidosis by seeing a doctor when the symptoms first appear. This can help prevent damage to the lungs, eyes, heart and other organs. Also, people with sarcoidosis should continue to follow up with their doctor after they have been diagnosed to monitor if the disease is progressing.

• #75 Sarcoidosis Treatment Options – Foundation for Sarcoidosis Research

  https://www.stopsarcoidosis.org/what-is-sarcoidosis/treatment-options/

  People with sarcoidosis may need to take corticosteroids for many months. […] Because sarcoidosis may be the result of an overreaction of the immune system, suppressing the immune system may ease symptoms and prevent further organ damage. […] When corticosteroids are not effective, your provider may talk with you about starting other medications, including methotrexate, azathioprine, and mycophenolate mofetil (CellCept). […] People with severe or advanced lung sarcoidosis may need oxygen therapy. […] In a few cases, lung transplantation the replacement of a diseased lung or lungs with a healthy donor lung is used to treat severe lung sarcoidosis.

• #76 Sarcoidosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sarcoidosis/diagnosis-treatment/drc-20350363

  Hydroxychloroquine. Hydroxychloroquine (Plaquenil) may be helpful for skin lesions and high blood-calcium levels. […] Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medicines are commonly used to treat inflammation from rheumatoid arthritis. They also can be helpful in treating sarcoidosis that hasn’t responded to other treatments. […] Depending on your symptoms or complications, you may need other treatments. For example, you may have: […] Physical therapy to lessen tiredness and strengthen muscles. […] Pulmonary rehabilitation to help ease breathing and do more activities. […] An organ transplant may be an option for some people if sarcoidosis has severely damaged the lungs, heart or liver. […] Your healthcare professional monitors your symptoms and checks to see if you need treatment, how treatments are working and if you have complications. Ongoing monitoring may include tests based on your condition. […] Follow-up care is likely lifelong.

• #77 Sarcoidosis Treatment | National Jewish Health

  https://www.nationaljewish.org/conditions/sarcoidosis/sarcoidosis-overview/treatment

  What is the Treatment for Sarcoidosis? Up to one-half of the people diagnosed with sarcoidosis improve without treatment. Those who do not improve are often placed on medicine to reduce inflammation. Many people will recover, but some will get worse despite treatment. The goals of treatment are to: Maintain good organ function […] Lessen symptoms […] Prevent organ damage […] Several medicines are used to treat sarcoidosis. Corticosteroids, which work to reduce inflammation, are the main treatment. Generally, prednisone (a tablet) is given daily or every other day, depending on the symptoms. Prednisone can decrease symptoms, improve lung function, reduce granuloma formation, and possibly lessen scarring of the lungs. Prednisone can be associated with a number of side effects. Because of this, your doctor will carefully monitor you. Prednisone is not the medication of choice for long-term management of sarcoidosis. For long-term management of sarcoidosis, steroid-sparing agents are often used. Methotrexate is an anti-inflammatory medicine. It is often used as a second-line medicine. It may be used with corticosteroids or after stopping corticosteroids. Other medicines are used if corticosteroids and methotrexate are not effective. These other medicines are not used often, since their effect on sarcoidosis is not as well understood. They also can have side effects. Oxygen therapy may be an important part of a treatment plan for people with severe sarcoidosis. It can help reduce heart and lung long-term problems caused by low oxygen levels. For people who develop chronic, progressive sarcoidosis, pulmonary rehabilitation also may be helpful. This includes exercise, healthy eating and education. Because treatment is so important, a person can improve the outcome of sarcoidosis by seeing a doctor when the symptoms first appear. This can help prevent damage to the lungs, eyes, heart and other organs. Also, people with sarcoidosis should continue to follow up with their doctor after they have been diagnosed to monitor if the disease is progressing.

• #78 Sarcoidosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sarcoidosis/diagnosis-treatment/drc-20350363

  Hydroxychloroquine. Hydroxychloroquine (Plaquenil) may be helpful for skin lesions and high blood-calcium levels. […] Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medicines are commonly used to treat inflammation from rheumatoid arthritis. They also can be helpful in treating sarcoidosis that hasn’t responded to other treatments. […] Depending on your symptoms or complications, you may need other treatments. For example, you may have: […] Physical therapy to lessen tiredness and strengthen muscles. […] Pulmonary rehabilitation to help ease breathing and do more activities. […] An organ transplant may be an option for some people if sarcoidosis has severely damaged the lungs, heart or liver. […] Your healthcare professional monitors your symptoms and checks to see if you need treatment, how treatments are working and if you have complications. Ongoing monitoring may include tests based on your condition. […] Follow-up care is likely lifelong.

• #79 Sarcoidosis Treatment | Sarcoidosis Research Institute

  https://www.sarcoidosisri.org/sarcoidosis/treatment/

  Non-steroidal anti-inflammatory drugs, or NSAIDS, are helpful in the reduction of acute inflammation and the relief of arthritic pain and fever. […] Organ transplants, such as lung, liver, and kidney transplants can be used to treat patients with sarcoidosis. […] Topical corticosteroids formulations are available as eye drops, skin creams, gels, lotions, and respiratory sprays; and can be helpful for mild local symptoms of sarcoidosis. […] While not a replacement for traditional medical treatment plans, complementary treatments can further reduce the severity and duration of sarcoidosis symptoms. […] Although all sarcoidosis patients, even those whose symptoms resolve on their own, should consult with their doctor, some patients will require a more in-depth plan for treating sarcoidosis. If symptoms are severe, you will likely be treated with medications, including corticosteroids, methotrexate, hydroxychloroquine, and other similar immunosuppressant medications. Treatment, and corresponding follow-up care, may be lifelong.

• #80 Sarcoidosis | Duke Health

  https://www.dukehealth.org/treatments/sarcoidosis

  Immunosuppressants can reduce symptoms by controlling your overactive immune system. […] Other medications treat specific symptoms. […] End-stage sarcoidosis may be treated with advanced therapies for specific organs, for example, oxygen therapy, left ventricular assist devices (LVADs), and dialysis. […] People with end-stage sarcoidosis that has caused organ failure may need an organ transplant. Lung, heart, and liver transplants are some of the most common. […] Our designated weekly sarcoidosis clinics bring multiple specialists together so you can see more than one doctor on the same day or even during the same appointment, if needed. […] This means we follow evidence-based guidelines and best practices for sarcoidosis treatment. […] Because sarcoidosis can affect multiple organs and body systems, a team approach ensures you receive the best-possible care. […] We provide care at all stages of sarcoidosis, from diagnosis to treatment and organ transplant for more advanced cases. […] Our doctors and providers are studying ways to improve sarcoidosis care.

• #81 Pulmonary Sarcoidosis Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/pulmonary-sarcoidosis/treatment-options

  Immunomodulators reduce inflammation by changing the activity of the immune system. […] Hydroxychloroquine or chloroquine these drugs, developed for the treatment of malaria, can help some sarcoidosis patients. […] Surgery is usually a last resort for people who have more severe sarcoidosis that has caused serious damage to organs. […] Lung transplantation is reserved for treating patients with very severe organ damage resulting from sarcoidosis. Organ transplants can significantly improve quality of life, but involve many risks, including the risk of infection and even death if the body rejects the transplanted organ.

• #82 Sarcoidosis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/sarcoidosis/sarcoidosis

  Adalimumab can be considered for patients with ocular or cutaneous sarcoidosis and in patients who have been treated successfully with infliximab but have developed antibodies or infusion reactions. […] Other treatment considerations […] Patients who have heart block or ventricular arrhythmias due to cardiac involvement should receive an implantable cardiac defibrillator and pacemaker in addition to pharmacotherapy. […] Tetracycline antibiotics such as doxycycline or minocycline can be tried for cutaneous sarcoidosis. […] No available medications have consistently prevented pulmonary fibrosis. […] Treatment of sarcoidosis-associated pulmonary arterial hypertension (SPAH) is supportive with diuresis and supplemental oxygen. The role of pulmonary vasodilators in treating SPAH has not been well established; a few small studies have suggested efficacy, but larger studies are needed to confirm it.

• #83 Sarcoidosis – UF Health

  https://ufhealth.org/conditions-and-treatments/sarcoidosis

  Sarcoidosis symptoms will often get better without treatment, especially if there are only small lung abnormalities. […] If the eyes, heart, nervous system, or lungs are affected, corticosteroids are usually prescribed. This medicine may need to be taken for 1 to 2 years. […] Medicines that suppress the immune system are sometimes also needed. […] In rare cases, people with very severe heart or lung damage (end-stage disease) may need an organ transplant. […] With sarcoidosis that affects the heart, an implantable cardioverter-defibrillator (ICD) may be needed to treat heart rhythm problems.

• #84 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Hydroxychloroquine and hydroxychloroquine (HCQ) are antimalaria drugs used to treat sarcoidosis. […] Mycophenolate mofetil (MMF) is a powerful inhibitor of lymphocyte proliferation, used to prevent allograft rejection after transplant. […] Anti-tumor necrosis factor- (anti-TNF-) agents are considered effective third-line drugs in sarcoidosis (especially with refractory pulmonary disease and neurosarcoidosis) by blocking TNF-, a significant cytokine in granulomatous inflammation. […] Treatment of CS is two-fold. […] Studies have shown long-term benefit of early initiation of immunosuppressives in CS. […] Corticosteroids in particular have shown survival and functional benefit, albeit not in randomized trials; lower doses of prednisone (no more than 30 mg) are not inferior to higher doses and are preferred.

• #85 Cardiac Sarcoidosis: Treatment & Diagnosis (MRI & PET scan)

  https://www.aerjournal.com/articles/management-cardiac-sarcoidosis-2020?language_content_entity=en

  The treatment of VA in CS includes medical therapy in the form of both anti-arrhythmic drugs and immunosuppression, device therapy in the form of secondary prevention ICD and catheter ablation. […] The mainstay of medical therapy for CS, as with other organ involvement, is immunosuppression, namely in the form of corticosteroids. In addition, a number of different steroid-sparing agents may be used to avoid untoward side-effects of chronic corticosteroid use. […] In the context of limited available data, the general approach to treatment of CS includes early initiation of prednisone at 30-40 mg/day, with subsequent monitoring and tapering as tolerated. […] Device therapy with permanent pacemakers and/or ICDs is an essential component of the therapeutic approach to patients with CS and arrhythmic events. […] Depending on the substrate (i.e. scar or inflammation mediated), catheter ablation may be an effective component of the therapeutic approach in patients with CS and VA.

• #86 Cardiac Sarcoidosis Diagnosis and Treatment: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/03/30/14/48/cardiac-sarcoidosis-phenotypes

  Cardiac sarcoidosis treatment is comprised of steroids (usually prednisone 0.5 mg/kg/day). Prednisone is tapered down every 4 weeks in decrements of 5-10 mg until a dose of 10 mg/day is achieved. Authors recommend steroid discontinuation after 12-16 months of treatment if there are no signs of disease activity with serial annual follow-up for 5 years followed by alternate year follow-up visits. […] Efficacy of treatment is checked with symptom assessment, ECG, arrhythmia burden, cardiac biomarkers, and left ventricular ejection fraction (LVEF). The authors recommend serial FDG-PET only if there is a discrepancy between clinical observations or if relapse or treatment failure is suspected. […] The authors recommend a second immunosuppressant (methotrexate, cellcept, azathioprine, leflunomide, and cyclophosphamide) when either steroids fail or there is a need to reduce steroid toxicity risk or with rapidly progressive heart failure, life-threatening arrhythmias, or extensive inflammation on imaging. Methotrexate is most commonly used but the authors prefer azathioprine 1-2 mg/kg weight with close follow-up for side effects.

• #87 Cardiac Sarcoidosis Diagnosis and Treatment: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/03/30/14/48/cardiac-sarcoidosis-phenotypes

  When all therapies fail, biological antitumor necrosis factor agents like infliximab may help. These agents need comprehensive screening for tuberculosis and vaccination. Authors use infliximab 5 mg/kg at weeks 0, 2, and 4 weeks and then every 8th week for 1 year or until inflammation subsides. […] For symptomatic ventricular arrhythmias, the effect of immunosuppression is not well established. If inflammation is detected, steroids are recommended with antiarrhythmics. If medical therapy fails, catheter ablation can be considered.

• #88 Sarcoidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0100/sarcoidosis.html

  Paramothayan S, Lasserson TJ, Walters EH. Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis. […] Adler BL, Wang CJ, Bui TL, et al. Anti-tumor necrosis factor agents in sarcoidosis. […] Rezaee M, Zangiabadian M, Soheili A, et al. Role of anti-tumor necrosis factor-alpha agents in treatment of sarcoidosis: a meta-analysis. […] Lower EE, Baughman RP. The use of low dose methotrexate in refractory sarcoidosis. […] Pereira J, Anderson NE, McAuley D, et al. Medically refractory neurosarcoidosis treated with infliximab. […] Gelfand JM, Bradshaw MJ, Stern BJ, et al. Infliximab for the treatment of CNS sarcoidosis. […] Fritz D, Timmermans WMC, van Laar JAM, et al. Infliximab treatment in pathology-confirmed neurosarcoidosis. […] Hamada H, Hayashi N, Kurimoto M, et al. Isolated third and fourth ventricles associated with neurosarcoidosis successfully treated by neuroendoscopycase report.

• #89 Sarcoidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0100/sarcoidosis.html

  Paramothayan S, Lasserson TJ, Walters EH. Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis. […] Adler BL, Wang CJ, Bui TL, et al. Anti-tumor necrosis factor agents in sarcoidosis. […] Rezaee M, Zangiabadian M, Soheili A, et al. Role of anti-tumor necrosis factor-alpha agents in treatment of sarcoidosis: a meta-analysis. […] Lower EE, Baughman RP. The use of low dose methotrexate in refractory sarcoidosis. […] Pereira J, Anderson NE, McAuley D, et al. Medically refractory neurosarcoidosis treated with infliximab. […] Gelfand JM, Bradshaw MJ, Stern BJ, et al. Infliximab for the treatment of CNS sarcoidosis. […] Fritz D, Timmermans WMC, van Laar JAM, et al. Infliximab treatment in pathology-confirmed neurosarcoidosis. […] Hamada H, Hayashi N, Kurimoto M, et al. Isolated third and fourth ventricles associated with neurosarcoidosis successfully treated by neuroendoscopycase report.

• #90 Sarcoidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0100/sarcoidosis.html

  Paramothayan S, Lasserson TJ, Walters EH. Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis. […] Adler BL, Wang CJ, Bui TL, et al. Anti-tumor necrosis factor agents in sarcoidosis. […] Rezaee M, Zangiabadian M, Soheili A, et al. Role of anti-tumor necrosis factor-alpha agents in treatment of sarcoidosis: a meta-analysis. […] Lower EE, Baughman RP. The use of low dose methotrexate in refractory sarcoidosis. […] Pereira J, Anderson NE, McAuley D, et al. Medically refractory neurosarcoidosis treated with infliximab. […] Gelfand JM, Bradshaw MJ, Stern BJ, et al. Infliximab for the treatment of CNS sarcoidosis. […] Fritz D, Timmermans WMC, van Laar JAM, et al. Infliximab treatment in pathology-confirmed neurosarcoidosis. […] Hamada H, Hayashi N, Kurimoto M, et al. Isolated third and fourth ventricles associated with neurosarcoidosis successfully treated by neuroendoscopycase report.

• #91 Sarcoidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0100/sarcoidosis.html

  Paramothayan S, Lasserson TJ, Walters EH. Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis. […] Adler BL, Wang CJ, Bui TL, et al. Anti-tumor necrosis factor agents in sarcoidosis. […] Rezaee M, Zangiabadian M, Soheili A, et al. Role of anti-tumor necrosis factor-alpha agents in treatment of sarcoidosis: a meta-analysis. […] Lower EE, Baughman RP. The use of low dose methotrexate in refractory sarcoidosis. […] Pereira J, Anderson NE, McAuley D, et al. Medically refractory neurosarcoidosis treated with infliximab. […] Gelfand JM, Bradshaw MJ, Stern BJ, et al. Infliximab for the treatment of CNS sarcoidosis. […] Fritz D, Timmermans WMC, van Laar JAM, et al. Infliximab treatment in pathology-confirmed neurosarcoidosis. […] Hamada H, Hayashi N, Kurimoto M, et al. Isolated third and fourth ventricles associated with neurosarcoidosis successfully treated by neuroendoscopycase report.

• #92 Sarcoidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0100/sarcoidosis.html

  Menninger MD, Amdur RJ, Marcus RB. Role of radiotherapy in the treatment of neurosarcoidosis. […] Drake WP, Oswald-Richter K, Richmond BW, et al. Oral antimycobacterial therapy in chronic cutaneous sarcoidosis. […] Khatri KA, Chotzen VA, Burrall BA. Lupus pernio: successful treatment with a potent topical corticosteroid. […] Wise RD. Clinical resolution of facial cutaneous sarcoidosis with systemic colchicine and a topical corticosteroid ointment. […] Fazzi P, Manni E, Cristofani R, et al. Thalidomide for improving cutaneous and pulmonary sarcoidosis in patients resistant or with contraindications to corticosteroids. […] Heidelberger V, Ingen-Housz-Oro S, Marquet A, et al. Efficacy and tolerance of anti-tumor necrosis factor agents in cutaneous sarcoidosis: a French study of 46 cases.

• #93 Sarcoidosis and your skin: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/sarcoidosis-treatment

  When sarcoidosis develops on the skin, its often an early sign of the disease. […] If you have sarcoidosis, you may need treatment. Most often, patients receive treatment for the area of the body where sarcoidosis is the worst. […] Mild skin sarcoidosis may go away on its own. If this seems likely, your dermatologist may suggest watching you rather than treating you. […] Dermatologists recommend treating the skin when you have: Sarcoidosis on your skin that can cause thickening skin, scarring, or permanent skin damage. […] If you need treatment for your skin, you will receive a treatment plan tailored to your needs. […] Here are the treatments for skin sarcoidosis that dermatologists use: Skin-directed treatment: For many patients, this type of treatment works well. […] Your dermatologist may prescribe one or more of the following: Medication you apply to your skin: Most patients apply a corticosteroid, pimecrolimus cream, or tacrolimus ointment.

• #94 Sarcoidosis and your skin: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/sarcoidosis-treatment

  When sarcoidosis develops on the skin, its often an early sign of the disease. […] If you have sarcoidosis, you may need treatment. Most often, patients receive treatment for the area of the body where sarcoidosis is the worst. […] Mild skin sarcoidosis may go away on its own. If this seems likely, your dermatologist may suggest watching you rather than treating you. […] Dermatologists recommend treating the skin when you have: Sarcoidosis on your skin that can cause thickening skin, scarring, or permanent skin damage. […] If you need treatment for your skin, you will receive a treatment plan tailored to your needs. […] Here are the treatments for skin sarcoidosis that dermatologists use: Skin-directed treatment: For many patients, this type of treatment works well. […] Your dermatologist may prescribe one or more of the following: Medication you apply to your skin: Most patients apply a corticosteroid, pimecrolimus cream, or tacrolimus ointment.

• #95 Sarcoidosis and your skin: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/sarcoidosis-treatment

  Laser or light therapy: For this to be effective, you may need several treatments and your dermatologist may need to try a few different types of laser or light treatments to find one that works for you. […] Injections of corticosteroids: Your dermatologist will inject this medication directly into the bump or other lesion. […] Treating the skin with medication that works throughout the body: If you need stronger treatment, your dermatologist may prescribe this type of medication. […] Medications your dermatologist may prescribe include: Hydroxychloroquine or chloroquine: These medications reduce inflammation, which can shrink the lesions on your skin. […] Methotrexate: This medication can stop sarcoidosis from developing on your skin. […] Corticosteroid pills: If you have widespread or disfiguring sarcoidosis on your skin or the disease hasn’t been helped by other treatment, this may be an option.

• #96 Sarcoidosis and your skin: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/sarcoidosis-treatment

  Thalidomide: This medication is prescribed when other treatments haven’t worked. […] A biologic: This medication can be helpful if sarcoidosis covers much of your skin, is disfiguring, or fails to respond to other treatments. […] Surgical removal: This is only considered as a possible treatment when a patient has severely disfiguring sarcoidosis and other treatments have failed to work. […] Sometimes, skin sarcoidosis can be a challenge to treat. […] One medication that shows promise is called a JAK inhibitor. […] To help patients with sarcoidosis prevent serious health problems, dermatologists recommend ongoing medical care when sarcoidosis is active.

• #97 Sarcoidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0100/sarcoidosis.html

  Lower EE, Baughman RP. Prolonged use of methotrexate for sarcoidosis. […] Marchetti M, Baker MG, Noland MMB. Treatment of subcutaneous sarcoidosis with hydroxychloroquine: report of 2 cases. […] Damsky W, Thakral D, McGeary MK, et al. Janus kinase inhibition induces disease remission in cutaneous sarcoidosis and granuloma annulare.

• #98 Sarcoidosis: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0100/sarcoidosis.html

  Lower EE, Baughman RP. Prolonged use of methotrexate for sarcoidosis. […] Marchetti M, Baker MG, Noland MMB. Treatment of subcutaneous sarcoidosis with hydroxychloroquine: report of 2 cases. […] Damsky W, Thakral D, McGeary MK, et al. Janus kinase inhibition induces disease remission in cutaneous sarcoidosis and granuloma annulare.

• #99

  https://link.springer.com/article/10.1007/s41030-021-00160-x

  Due to frequent lung involvement, the pulmonologist is often the reference physician for management of sarcoidosis, a systemic granulomatous disease with a heterogeneous course. Treatment of sarcoidosis raises some issues. The first challenge is to select patients who are likely to benefit from treatment, as sarcoidosis may be self-limiting and remit spontaneously, in which case treatment can be postponed and possibly avoided without any significant impact on quality of life, organ damage or prognosis. Systemic glucocorticosteroids (GCs) are the drug of first choice for sarcoidosis. When GCs are started, there is a 50% chance of long-term treatment. Prolonged use of prednisone at 10 mg/day or equivalent is often associated with severe side effects. In these and refractory cases, steroid-sparing options are advised. Antimetabolites, such as methotrexate, are the second-choice therapy. Biologics, such as anti-TNF and especially infliximab, are third-choice drugs. The three treatments can be used concomitantly. Regardless of whether treatment is started, the clinician needs to organize regular follow-up to monitor remissions, flares, progression, complications, toxicity and relapses in order to promptly adjust the drugs used.

• #100 Sarcoidosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sarcoidosis/diagnosis-treatment/drc-20350363

  Hydroxychloroquine. Hydroxychloroquine (Plaquenil) may be helpful for skin lesions and high blood-calcium levels. […] Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medicines are commonly used to treat inflammation from rheumatoid arthritis. They also can be helpful in treating sarcoidosis that hasn’t responded to other treatments. […] Depending on your symptoms or complications, you may need other treatments. For example, you may have: […] Physical therapy to lessen tiredness and strengthen muscles. […] Pulmonary rehabilitation to help ease breathing and do more activities. […] An organ transplant may be an option for some people if sarcoidosis has severely damaged the lungs, heart or liver. […] Your healthcare professional monitors your symptoms and checks to see if you need treatment, how treatments are working and if you have complications. Ongoing monitoring may include tests based on your condition. […] Follow-up care is likely lifelong.

• #101 Sarcoidosis Treatment & Management: Medical Care, Surgical Care, Long-Term Monitoring

  https://emedicine.medscape.com/article/301914-treatment

  For extrapulmonary sarcoidosis involving such critical organs as the heart, liver, eyes, kidneys, or central nervous system, medical intervention is indicated. […] Topical corticosteroids are effective for ocular disease. […] Lung transplantation is a viable option for patients with stage IV sarcoidosis. […] Monitor pulmonary function and chest radiography every 6-12 months. […] Assess for progression or resolution. […] Determine if previously uninvolved organs have become affected.

• #102 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  The most efficient drug against sarcoidosis is undisputedly corticosteroids. […] Corticosteroids remain the mainstay first-line treatment of sarcoidosis. […] These effects are short-term, lasting for a period of 1 to 2 years, and fade after treatment withdrawal. […] When initiating corticosteroids in a patient with sarcoidosis, close follow-up every 3 months is mandatory. […] Based on existing literature, several principles apply when considering treating pulmonary sarcoidosis with corticosteroids: (1) acute disease and flares of chronic disease require the same prednisone doses, (2) the chronic maintenance dose should be the lowest possible, and (3) treatment with corticosteroids should be fairly prolonged to allow clearance of the etiologic antigen and adequate suppression of granulomatous reaction.

• #103 Sarcoidosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sarcoidosis/diagnosis-treatment/drc-20350363

  Hydroxychloroquine. Hydroxychloroquine (Plaquenil) may be helpful for skin lesions and high blood-calcium levels. […] Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medicines are commonly used to treat inflammation from rheumatoid arthritis. They also can be helpful in treating sarcoidosis that hasn’t responded to other treatments. […] Depending on your symptoms or complications, you may need other treatments. For example, you may have: […] Physical therapy to lessen tiredness and strengthen muscles. […] Pulmonary rehabilitation to help ease breathing and do more activities. […] An organ transplant may be an option for some people if sarcoidosis has severely damaged the lungs, heart or liver. […] Your healthcare professional monitors your symptoms and checks to see if you need treatment, how treatments are working and if you have complications. Ongoing monitoring may include tests based on your condition. […] Follow-up care is likely lifelong.

• #104 Sarcoidosis Causes, Symptoms, and Treatments

  https://www.upmc.com/services/pulmonology/conditions/sarcoidosis

  Other important lifestyle changes you should make: Avoid alcohol and smoking cigarettes. Alcohol can damage your liver, especially if you are taking sarcoidosis medications. Smoking can worsen your lung symptoms. […] Eat a healthy diet. Limit your sugar intake and focus on a whole-food diet that includes fruits, vegetables, whole grains, and protein. […] Manage stress. Stress-reduction techniques can improve your well-being, especially with a chronic condition like sarcoidosis. […] Stay physically active. Finding an exercise routine or sport you enjoy will help strengthen your muscles and boost your mood. Bonus points if you can get active outside!

• #105 Sarcoidosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/11863-sarcoidosis

  It can take anywhere from a few weeks to a few months for you to notice symptom improvement after starting treatment for sarcoidosis. Your healthcare provider will monitor you and may perform tests again to see if the treatment is working. […] Some research suggests that certain diets reduce inflammation in the body. Eating plant-based foods (like fruits and vegetables), limiting meat and cheese, and avoiding sugar and carbohydrates (like breads) may help improve your sarcoidosis symptoms. Ask your healthcare provider before starting a new diet.

• #106 State-of-the-Art Treatments for Sarcoidosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9237819/

  Patients with advanced disease, pulmonary fibrosis, pulmonary hypertension, cardiac sarcoidosis, and neurosarcoidosis should be thoroughly identified and treated accordingly. […] Treatment of a patient with sarcoidosis should take into account not only physiologic impairment of the organ but also quality of life and patient-reported outcomes. […] Corticosteroids, the first-line treatment for acute and chronic disease, should be employed at the lowest affordable dose. […] To allow this, steroid-sparing agents, in particular methotrexate, are useful and effective. […] Infliximab, among anti-TNF agents, is effective in refractory pulmonary, cutaneous, and neurosarcoidosis. […] Fatigue and small fiber neuropathy impose significant burdens to patients, and efforts should be made to relieve them.

• #107 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Additional therapies targeting a variety of pathogenic mechanisms are also undergoing further study, but do not have enough evidence yet to be incorporated into treatment recommendations. […] Management decisions should evolve to include personalized medicine based on pharmacogenomics and sarcoidosis phenotype, as well as patient-centered approaches to incorporate immunosuppression, symptom control, and treatment of comorbid conditions.

• #108 American Thoracic Society | Treatment of Sarcoidosis

  https://site.thoracic.org/advocacy-patients/patient-resources/treatment-of-sarcoidosis

  Sarcoidosis varies in how active and how severe it is for each person and over time. […] Treatment is aimed at maintaining good function of the organ involved, reducing symptoms, improving quality of life, and preventing organ damage. […] There are two reasons to treat sarcoidosis: concern for developing organ damage (including respiratory failure) and/or to improve quality of life. […] Medications to treat inflammation in sarcoidosis include corticosteroids. The most common corticosteroid prescribed for sarcoidosis is prednisone. […] Research continues to try to find new treatment for sarcoidosis. Other drugs are currently being tested in clinical trials. […] Some people with advanced lung disease because of sarcoidosis may be eligible to receive a lung transplant. […] Talk with your healthcare provider about whether you need treatment for sarcoidosis and what options you have.

• #109 Treatment of Sarcoidosis: A Multidisciplinary Approach

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7732561/

  Additional therapies targeting a variety of pathogenic mechanisms are also undergoing further study, but do not have enough evidence yet to be incorporated into treatment recommendations. […] Management decisions should evolve to include personalized medicine based on pharmacogenomics and sarcoidosis phenotype, as well as patient-centered approaches to incorporate immunosuppression, symptom control, and treatment of comorbid conditions.

• #110 Sarcoidosis: Treatment for your lungs, heart, eyes, and more | University of Iowa Health Care

  https://uihc.org/services/sarcoidosis

  No matter what part of your body is affected by sarcoidosis, we can help you control your symptoms and prevent complications. […] Thanks to modern treatments, people with sarcoidosis have a much better quality of life than in the past. But the key to getting sarcoidosis under control and preventing serious complications is an early and accurate diagnosis. […] You can also take comfort in knowing we offer the treatments you need to live well with sarcoidosis. Whether it affects your lungs, heart, or other organs, we have specialists who can help. […] With proper diagnosis and treatment, most people with sarcoidosis can expect to live a long, full life. […] Our goal is to provide treatments that control the inflammation from sarcoidosis. This means your symptoms go away for months or even years.

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