title: Treatment of Sarcoidosis.
abstract: In general, sarcoidosis treatment should be offered to palliate symptoms and improve quality of life or to prevent end-organ disease. Symptoms include pulmonary as well as extra-pulmonary manifestations of the disease. The assessment of response to disease includes functional studies such as the forced vital capacity. Radiologic imaging such as chest x-ray has also been used to assess response, although standardized measures have rarely been tested. There are sufficient clinical trials to make specific recommendations regarding treatment of symptomatic pulmonary disease. Initial therapy is usually prednisone or a similar glucocorticoid. However, there are several features of this treatment which are unknown. This includes the initial dose, timing of reduction of dose, and when to discontinue treatment. Since many patients are intolerant of prednisone, steroid-sparing alternatives have been studied. Methotrexate is the most widely used anti-metabolite, but azathioprine, leflunomide, and mycophenolate have also been reported as helpful. The biologic agents, especially monoclonal anti-tumor necrosis factor (anti-TNF) antibodies, have proved effective in patients who have failed other treatments. Infliximab, the most widely studied anti-TNF antibody, has proved effective for a range of refractory sarcoidosis. However, there remain questions regarding dose and duration of therapy. For the clinician, the many treatment options allow for a specific treatment regimen for each patient which minimizes risk while enhancing benefit.
authors.affiliation: University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA, bob.baughman@uc.edu.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Baughman
authors.forename: Elyse E
authors.initials: EE
authors.lastname: Lower
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D006099:Granuloma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D008168:Lung / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012129:Respiratory Function Tests; D012507:Sarcoidosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D012867:Skin / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; D007555:Isoxazoles; D000069285:Infliximab; D000077339:Leflunomide; D009173:Mycophenolic Acid; D001379:Azathioprine; D011241:Prednisone; D008727:Methotrexate