20th February 2025

Management of sarcoidosis

Oral glucocorticoids are indicated in certain contexts:

• With significant reduction in pulmonary function tests
• With eye, heart or neurological involvement

Second-line immunosuppression may be considered, with agents such as methotrexate, mycophenolate, leflunomide and azathioprine. This is indicated when steroid therapy is not appropriate or ineffective, e.g. if there is progression of pulmonary disease or an unacceptable symptom burden despite steroids, inability to taper steroids below 10-15 mg per day, inability to tolerate steroids, in the presence of comorbidities that would be adversely affected by steroids therapy, or if a patient refuses to take steroids.

Biological therapy is a third-line option only available through tertiary centres. This includes TNF inhibitors.

Lung transplantation may be considered.

See note on nintedanib – this has now been approved as a treatment option for chronic progressive fibrosing interstitial lung diseases.