Synthetic pharmacotherapy for pulmonary sarcoidosis

ABSTRACT

Introduction: Sarcoidosis is a granulomatous systemic disease of unknown cause where the lungs are the most frequently affected. Therapeutic management of the disease is challenging as clinical presentation and prognosis are very heterogeneous.

Areas covered: This review summarizes the current knowledge of synthetic therapies for pulmonary sarcoidosis. The most commonly used medication for the treatment of sarcoidosis with lung involvement are glucocorticoids. Nevertheless, not all patients reach an acceptable response or tolerate them and the use of second-line treatments like immunosuppressive agents are necessary. Other kind of drugs could be used but there is no solid evidence and most of them are currently under investigation.

Expert opinion: The majority of patients with pulmonary sarcoidosis do not require treatment and their sarcoidotic lung lesions could regress. However, it is important to treat the disease in those cases that could develop organ failure. Although the number of studies of therapies for pulmonary sarcoidosis have increased in recent years, the information available is still limited and there is no consensus on how to monitor the activity of the disease.

KEYWORDS:

• Glucocorticoids
• Immunosuppressive Therapy
• Pulmonary Sarcoidosis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Sarcoidosis is a multisystem disease being the lung the most frequently involved organ and the first cause of morbimortality.

• Not all the patients require treatment. Consider therapy when there are respiratory symptoms, abnormal functional studies, and radiological involvement.

• Evaluate disease activity in advanced pulmonary sarcoidosis before treatment.

• Corticosteroids are the first line choice but other alternatives can be considered when the refractory disease is present or toxic effects appeared.

• More studies are needed to define the optimal way to follow up the disease

This box summarizes the key points contained in the article.

Additional information

Funding

This manuscript has not been funded.