Sarcoidosis Medication

  • Author: Nader Kamangar, MD, FACP, FCCP, FCCM; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Jul 29, 2011
 

Medication Summary

Because medical treatment focuses on anti-inflammatory therapies, corticosteroids remain the foundation of treatment.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

NSAIDs are indicated for the treatment of arthralgias and other rheumatic complaints. Patients with stage I sarcoidosis often require only occasional treatment with NSAIDs.

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Ibuprofen (Motrin, Ibuprin, Advil)

 

Ibuprofen and other NSAIDs are useful in the management of joint complaints. They are not indicated for treatment of significant pulmonary disease.

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Ketoprofen (Actron, Orudis, Oruvail)

 

For relief of mild to moderate pain and inflammation.

Small initial dosages are indicated in small and elderly patients and in those with renal or liver disease.

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Corticosteroids

Class Summary

The cornerstone of therapy; have potent immunologic effects that ameliorate many signs and symptoms.

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Prednisone (Deltasone, Orasone, Sterapred)

 

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

Response may be rapid but often is seen over 12-16 wk.

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Antimetabolites

Class Summary

Given the adverse side-effect profile of corticosteroids, methotrexate has recently received significant attention as either a corticosteroid alternative or a corticosteroid-sparing agent.

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Methotrexate (Folex PFS, Rheumatrex)

 

Antimetabolite that interferes with folate metabolism. Has been very successful in treating rheumatoid arthritis. The effects often take months to manifest, so it should be used initially with corticosteroids. As the drug's level increases, corticosteroids can be tapered.

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Antimalarial agents

Class Summary

Previously employed for the treatment of rheumatoid arthritis. Literature supporting its use in sarcoidosis is limited to case series. Has a relatively benign side-effect profile.

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Hydroxychloroquine (Plaquenil)

 

May be most useful in the management of osseous involvement. Inhibits chemotaxis of eosinophils, locomotion of neutrophils, and impairs complement-dependent antigen-antibody reactions.

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Contributor Information and Disclosures
Author

Nader Kamangar, MD, FACP, FCCP, FCCM  Associate Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Los Angeles, David Geffen School of Medicine, Olive View-UCLA Medical Center; Associate Program Director, Pulmonary and Critical Care Multi-Campus Fellowship Program, Cedars-Sinai/West Los Angeles Veterans Affairs/Los Angeles Kaiser Permanente/Olive View-UCLA Medical Center; Site Director, Pulmonary/Critical Care Fellowship Program, Olive View-UCLA Medical Center

Nader Kamangar, MD, FACP, FCCP, FCCM is a member of the following medical societies: American Academy of Sleep Medicine, American Association of Bronchology, American College of Chest Physicians, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, California Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew F Shorr, MD, MPH  Assistant Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Uniformed Services University of the Health Sciences

Andrew F Shorr, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP  Professor of Genomics and Personalized Medicine Research, Internal Medicine, and Pediatrics, Associate Director, Center for Genomics and Personalized Medicine Research, Director of Research, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi

Disclosure: See below for list of all activities None None

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H  Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

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Stage I sarcoidosis.
Stage II sarcoidosis.
Stage III sarcoidosis.
Noncaseating granuloma.
Table 1. Prognosis
StageRemission (%)Asymptomatic at 5 y (%)CXR Clearing (%)Mortality (%)
Stage I60-9095540
Stage II40-70583111
Stage III10-20251018
Stage IV0N/A0N/A
Table 2. Results of Multicenter Trial Sponsored by the British Thoracic Society
CharacteristicsGroup L*Group S†P
Dyspnea score (range 1-4)0.240.47NS
Fibrosis score (range 0-16)0.831.47NS
FEV1‡ (% predicted)95.986.90.05
VC§ (% predicted)99.890.80.02
DLCOII (% predicted)84.377.7NS
Weight gain (kg)+3.26+0.990.02
*Long-term steroids



†Short bursts of steroids



‡Forced expiratory volume in 1 second



§Ventilatory capacity



II Diffusing capacity of lung for carbon monoxide



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