[Sarcoidosis treatment].
Sarcoidosis treatment suppresses the granulomatous process and its clinical, functional and radiographic consequences but it is not etiological. Only a minority of patients necessitate systemic therapy. This is definitely required in severe extra-respiratory sarcoidosis including cardiac, neurological, renal, ocular involvement not responding to topical therapy and malignant hypercalcemia. Respiratory indications for therapy include symptomatic stage II/III showing significant physiologic impairment or progressive disease, and stage IV with persistent signs of activity. As a general rule, systemic corticosteroids are the first-line treatment, given for at least 12 months. One of the following sparing agents can be associated with steroids when the threshold level to control the disease is high: hydroxychloroquine, methotrexate or azathioprine. An alternative option to corticosteroids is proposed in case of contra-indication or cortico-resistant sarcoidosis; methotrexate is then the treatment of choice. Although other drugs are only occasionnally needed, the available therapeutical range is wide (thalidomide, infliximab, cyclophosphamide, leflunomide...).
Nunes
Hilario
H
Service de pneumologie, hôpital Avicenne AP-HP, université Paris-Nord 13, 93009 Bobigny cedex, France. hilario.nunes@avc.aphp.fr
Uzunhan
Yurdagul
Y
Bonnet
Daniel
D
Valeyre
Dominique
D
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D012507:Sarcoidosis / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents