Sarcoidosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roshan Dinparasti Saleh M.D.
Overview
Most sarcoidosis patients experience disease remission within the first 3 years of diagnosis with no long-term complications but one-third of patients have persistent disease, which causes organ failure. The treatment requires consideration of sarcoidosis-related complications and treatment side effects.
Medical Therapy
Most sarcoidosis patients experience disease remission within the first 3 years of diagnosis with no long-term complications but one-third of patients have persistent disease, which causes organ failure. The treatment requires consideration of sarcoidosis-related complications and treatment side effects.[1][2]
Not all patients require therapy at first[3][4][5]. The decision to treat the patients is based on symptoms and organ function impairment[4]
- Corticosteroids are the most commonly used and most effective medications for sarcoidosis[6][7][8]. Patients who do not respond to prednison 40 mg daily, are named refractory to standard treatment and can be considered for alternative treatments. Significant percentage of patients will require long-term treatment with corticosteroids, thus corticosteroid-sparing agents are being considered in this patients to avoid the cumulative side effects of the corticosteroids[9]
- Antimalarial agents are effective in cutaneous, sinonasal disease and hypercalcemia[10][11][12]
- Methotrexate has been shown to be effective in ocular, cutaneous, sinus, and neurologic disease[13][14][15][16][17][18]
- Azathioprine can be effective in pulmonary and extra-pulmonary disease[19]
- Mycophenolate analogues are effective against inflammatory lung disease[20][21]
- Infliximab is effective against refractory cases of pulmonary, lupus pernio, eye, and neurologic disease[22][23][24]
- Adalimumab is effective in some sarcoid cases[25][26]
References
- ↑ Baughman RP, Nunes H: Therapy for sarcoidosis: evidence-based recommendations. Expert Rev Clin Immunol 8(1):95–103, 2012.
- ↑ Guyatt G, Gutterman D, Baumann MH, et al: Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest 129(1):174–181, 2006.
- ↑ Gibson GJ, Prescott RJ, Muers MF, et al: British Thoracic Society Sarcoidosis study: effects of long term corticosteroid treatment. Thorax 51(3):238–247, 1996.
- ↑ 4.0 4.1 Baughman RP, Judson MA, Teirstein AS, et al: Presenting characteristics as predictors of duration of treatment for sarcoidosis. QJM 99(5):307–315, 2006.
- ↑ Hunninghake GW, Gilbert S, Pueringer R, et al: Outcome of the treatment for sarcoidosis. Am J Respir Crit Care Med 149(4 Pt 1):893–898, 1994.
- ↑ Baughman RP, Nunes H, Sweiss NJ, Lower EE: Established and experimental medical therapy of pulmonary sarcoidosis. Eur Respir J 41:1424–1438, 2013
- ↑ Paramothayan S, Jones PW: Corticosteroid therapy in pulmonary sarcoidosis: a systematic review. JAMA 287:1301–1307, 2002.
- ↑ Schutt AC, Bullington WM, Judson MA: Pharmacotherapy for pulmonary sarcoidosis: a Delphi consensus study. Respir Med 104(5):717–723, 2010.
- ↑ Baughman RP, Meyer KC, Nathanson I, et al: Monitoring of nonsteroidal immunosuppressive drugs in patients with lung disease and lung transplant recipients: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 142(5):e1S–e111S, 2012.
- ↑ Siltzbach LE, Teirstein AS: Chloroquine therapy in 43 patients with intrathoracic and cutaneous sarcoidosis. Acta Med Scand 425:302S–308S, 1964.
- ↑ Baltzan M, Mehta S, Kirkham TH, Cosio MG: Randomized trial of prolonged chloroquine therapy in advanced pulmonary sarcoidosis. Am J Respir Crit Care Med 160(1):192–197, 1999.
- ↑ Adams JS, Diz MM, Sharma OP: Effective reduction in the serum 1,25-dihydroxyvitamin D and calcium concentration in sarcoidosisassociated hypercalcemia with short-course chloroquine therapy. Ann Intern Med 111(5):437–438, 1989.
- ↑ Webster GF, Razsi LK, Sanchez M, Shupack JL: Weekly low-dose methotrexate therapy for cutaneous sarcoidosis. J Am Acad Dermatol 24:451–454, 1991.
- ↑ Mosam A, Morar N: Recalcitrant cutaneous sarcoidosis: an evidencebased sequential approach. J Dermatolog Treat 15(6):353–359, 2004.
- ↑ Henderson CA, Ilchyshyn A, Curry AR: Laryngeal and cutaneous sarcoidosis treated with methotrexate. J R Soc Med 87:632–633, 1994.
- ↑ Braun JJ, Gentine A, Pauli G: Sinonasal sarcoidosis: review and report of ifteen cases. Laryngoscope 114(11):1960–1963, 2004.
- ↑ Maust HA, Foroozan R, Sergott RC, et al: Use of methotrexate in sarcoid-associated optic neuropathy. Ophthalmology 110(3):559–563, 2003.
- ↑ Lower EE, Broderick JP, Brott TG, Baughman RP: Diagnosis and management of neurologic sarcoidosis. Arch Intern Med 157:1864–1868, 1997.
- ↑ Muller-Quernheim J, Kienast K, Held M, et al: Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen. Eur Respir J 14:1117–1122, 1999.
- ↑ Swigris JJ, Olson AL, Fischer A, et al: Mycophenolate mofetil is safe, well tolerated, and preserves lung function in patients with connective tissue disease-related interstitial lung disease. Chest 130:30–36, 2006.
- ↑ Zamora AC, Wolters PJ, Collard HR, et al: Use of mycophenolate mofetil to treat scleroderma-associated interstitial lung disease. Respir Med 102:150–155, 2008.
- ↑ Doty JD, Mazur JE, Judson MA: Treatment of sarcoidosis with inliximab. Chest 127(3):1064–1071, 2005.
- ↑ Sweiss NJ, Welsch MJ, Curran JJ, Ellman MH: Tumor necrosis factor inhibition as a novel treatment for refractory sarcoidosis. Arthritis Rheum 53(5):788–791, 2005.
- ↑ Stagaki E, Mountford WK, Lackland DT, Judson MA: The treatment of lupus pernio: results of 116 treatment courses in 54 patients. Chest 135(2):468–476, 2009.
- ↑ Baughman RP, Lower EE, Ingledue R, Kaufman AH: Management of ocular sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 29:26–33, 2012.
- ↑ Erckens RJ, Mostard RL, Wijnen PA, et al: Adalimumab successful in sarcoidosis patients with refractory chronic non-infectious uveitis. Graefes Arch Clin Exp Ophthalmol 250:713–720, 2012.