Difficult treatment issues in sarcoidosis.
The management of sarcoidosis includes several crucial decisions. Not all patients with sarcoidosis need treatment. At least a third of patients will never be treated. It is unclear whether asymptomatic patients ever need therapy, even if they have extensive lung disease. One reason that clinicians are reluctant to start therapy is that many patients who are started on corticosteroids have a difficult time getting off therapy, even after 2 years. In the chronic patient, alternatives to corticosteroids have been developed. These include drugs such as methotrexate, azathioprine and hydroxychloroquine. These agents have been the standard second line of therapy for patients with chronic disease. However, these drugs do not always work. In addition, they are associated with their own toxicities. Another group of sarcoidosis patients have also emerged. These are the refractory patients, who have progressive disease whilst on therapy. For these patients, new agents such as thalidomide and the monoclonal antibodies to tumour necrosis factor have been occasionally helpful. This paper reviews several important issues in the management of sarcoidosis.
Baughman
R P
RP
Interstitial Lung Disease and Sarcoidosis Clinic, University of Cincinnati, Cincinnati, OH 45267-0564, USA. baughmrp@ucmail.uc.edu
Lynch
J P
JP
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003657:Decision Making; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D008727:Methotrexate / Q000627:therapeutic use; D012507:Sarcoidosis / Q000188:drug therapy*; D013792:Thalidomide / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D000962:Antimalarials; D007166:Immunosuppressive Agents; D013792:Thalidomide; D003520:Cyclophosphamide; D000069285:Infliximab; D001379:Azathioprine; D008727:Methotrexate