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Purpose of Review <p>Sarcoidosis presents a complex challenge for clinicians in discerning the need for initiation of potentially toxic, but disease-modifying immunosuppressive therapies targeting granulomatous inflammation. In this review, we summarize the latest research on indications for treatment in high-risk pulmonary sarcoidosis and evidence supporting the most frequently utilized therapies. This article also addresses the initial evaluation of extrapulmonary manifestations of sarcoidosis to guide appropriate triage for multidisciplinary management of this highly morbid condition.</p> Recent findings <p>For the management of high-risk pulmonary sarcoidosis, glucocorticoids remain the first-line therapeutic intervention for improving both symptoms and pulmonary function. While methotrexate is recommended as a steroid-sparing agent for persistent pulmonary sarcoidosis, there is an increasing role for the adjunctive use of TNF-alpha inhibition in refractory disease.</p> Summary <p>The decision to initiate immunosuppressive therapy for sarcoidosis must be informed by the consideration of long-term risk for irreversible end-organ injury, the presence of significant impairment to an individual’s quality of life, and the risk for drug toxicity from treatment.</p>

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An Updated Review on Treatment of Pulmonary Sarcoidosis and Multisystem Disease Monitoring

  • 期刊论文

  • 发表日期：

    2025年9月8日

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  • Michael Marll,
  • Adam Fawaz,
  • Adam Shaver

摘要

Purpose of Review

Sarcoidosis presents a complex challenge for clinicians in discerning the need for initiation of potentially toxic, but disease-modifying immunosuppressive therapies targeting granulomatous inflammation. In this review, we summarize the latest research on indications for treatment in high-risk pulmonary sarcoidosis and evidence supporting the most frequently utilized therapies. This article also addresses the initial evaluation of extrapulmonary manifestations of sarcoidosis to guide appropriate triage for multidisciplinary management of this highly morbid condition.

Recent findings

For the management of high-risk pulmonary sarcoidosis, glucocorticoids remain the first-line therapeutic intervention for improving both symptoms and pulmonary function. While methotrexate is recommended as a steroid-sparing agent for persistent pulmonary sarcoidosis, there is an increasing role for the adjunctive use of TNF-alpha inhibition in refractory disease.

Summary

The decision to initiate immunosuppressive therapy for sarcoidosis must be informed by the consideration of long-term risk for irreversible end-organ injury, the presence of significant impairment to an individual’s quality of life, and the risk for drug toxicity from treatment.