Refractory Sarcoidosis: A Review

Figures & data

Table 1 Main Differential Diagnoses to Exclude in Sarcoidosis

Sarcoidosis Subtype	Possible Differential Diagnosis
Mediastino pulmonary sarcoidosis	Tuberculosis and mycobacterial infections
	Hodgkin disease and non-Hodgkin’s lymphoma
	Histoplasmosis, coccidioidomycosis, aspergillosis
	Pneumoconiosis: chronic beryllium disease, titanium, aluminium, talc
	Hypersensitivity pneumonitis
	Drug reactions
	Granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis
Extra thoracic sarcoidosis	Tuberculosis and mycobacterial infections
	Whipple disease, bartonellosis, Q fever, brucellosis, syphilis, toxoplasmosis, fungal infections
	Hodgkin disease and non-Hodgkin’s lymphoma
	Tumor associated sarcoid reaction
	Crohn’s disease, primary biliary cirrhosis
	Drug induced sarcoidosis (interferon α and β, intravesical BCG therapy, TNFα inhibitors, immune check point inhibitors)
	Common variable immunodeficiency

Abbreviations: BCG, Bacillus Calmette et Guérin; TNF, tumor necrosis factor.

Table 2 Indications for the Treatment of Sarcoidosis

Indications	Treatment
Cardiac, neurologic, kidney sarcoidosis	General corticosteroid therapy
Ocular sarcoidosis, not responding to topical therapy or bilateral posterior uveitis
Severe pulmonary sarcoidosis (intractable cough, dyspnea on exertion)
Laryngeal or nasosinusal sarcoidosis
Severe liver sarcoidosis
Incapacitating general symptoms
Malignant hypercalcemia
Progressive deterioration of pulmonary function
Contraindication to corticosteroids	Immunosuppressive drugs (methotrexate > azathioprine)
Refractory sarcoidosis (corticoresistance)
When cortisone-sparing effect is required (prednisone >10 mg/day)
Severe cardiac or neurologic sarcoidosis, refractory to corticosteroids
Severe sarcoidosis, refractory to other treatments	Anti-TNF-α (infliximab or adalimumab)

Abbreviation: TNF-α, tumor necrosis factor-α.

Table 3 Main Anti-Inflammatory Drugs in Sarcoidosis

Drugs	Line n°	Efficacy Evidence	Usual Dose	Main Contra Indications or Limitations	Main Adverse Effects	Comments
Corticosteroids	1	Very high	Up to 40 mg/d initially and 5 to 10 mg/d in maintenance therapy	Unstable psychiatric disorders, infection, unstable cardiomyopathy, unstable diabetes, severe osteoporosis	Weight gain, osteoporosis, diabetes, infections, hypertension	Rapid onset of efficacy but multiple adverse events if prolonged treatment
Methotrexate	2	High	10 to 25 mg weekly (subcutaneous injections or oral intake)	Chronic kidney failure, hepatic failure, infection, pregnancy, important alterations in lung function tests (especially FVC) due to risk of MTX induced pneumopathy	Leucopenia, anemia, thrombopenia, digestive disorders, infections, renal impairment, abnormal liver tests, drug induced pneumonia	Preferred 2nd line treatment, contraception needed
Leflunomide	2	Low/few data	20 mg/d	Planned pregnancy, hypertension, liver and renal failure	Digestive disorders, hypertension, neutropenia, drug induced pneumonia (rare)	Well tolerated, contraception needed
Azathioprine	2	High	2-3 mg/kg/d	Use of allopurinol, TPMT polymorphism	Digestive disorders, skin carcinoma, liver and blood cell toxicity	Available during pregnancy, measurement of drug metabolites in blood available
Mycophenolate mofetil	2	Very low/few data	2–3 g/d	Planned pregnancy, infections	Digestive disorders, neoplasia/lymphoma, skin carcinoma	Contraception needed, few available data
Cyclophosphamide	2	Low/few data	750 mg/m2 IV pulse (oral form must be abandoned because of high rates of hematological malignancies)	Planned pregnancy, cytopenia, infections	Cytopenia, severe infections (pneumocystosis), hemorrhagic cystitis, bladder neoplasia	Contraception needed, infertility risk (gametocytes preservation)
Aminoquinolines	2	Low	200–400 mg/d	Macula impairment, QT interval elongation	Digestive disturbance, retinal impairment, cardiac impairment (rare but severe)	When urgent response is not needed. Possible for arthritis and skin involvement. Useful in hypercalcemia
Thalidomide	2	Very low	50–200 mg/d + thromboprophylaxis	Planned pregnancy	Teratogenicity, peripheral neuropathy, deep vein thrombosis	Dubious efficacy, severe complications, not recommended
Infliximab	3	Very High	3–5 mg/kg at week 0, 2, 6 then every 4–8 weeks	Planned pregnancy, severe chronic heart failure, tuberculosis	Infections, allergic reactions, increased risk of carcinoma, immunization, drug induced lupus, demyelination	Very useful in severe refractory sarcoidosis, association with methotrexate if infliximab antibodies are found in order to increase infliximab blood levels
Adalimumab	3	Low	40 mg every 2 weeks (first injection may be done at higher dosage in cases where rapid response is needed, up to 160 mg)	Planned pregnancy, tuberculosis, latex allergy, severe chronic heart failure	Immunization, infections, local allergy, demyelination	Indicated in refractory sarcoidosis if failure of infliximab
Rituximab	4	Very low	375 mg/m2 every week for 4 weeks or 1g day 1 and day 15 then every 4–6 months (1g or 375 mg/m2)	Infection, instable chronic heart failure, planned pregnancy	Infections, neutropenia, hypogammaglobulinemia, anaphylactoid reactions/cytokines release syndrome	Not recommended
Tocilizumab	4	Very low	8 mg/kg/month	Infection, history of gastrointestinal disorders (ulcers, perforation), planned pregnancy	Infections, intestinal perforation, lipid metabolism disorders, liver tests perturbation	Could be useful in case of eye involvement with macular edema
JAKi (tofacitinib, ruxolitinib, baricitinib)	4	Very low	ruxolitinib: 20 mg twice a day; tofacitinib: 5 mg twice a day; baricitinib: 4 mg/d (2 mg if > 75 years old)	Infections, planned pregnancy	Herpes zoster infections, lipid metabolism disorders, cytopenia	Further studies needed but seems promising in case of refractory disease unregarding of organ involvement
Apremilast	4	Low	30 mg twice a day	Unstable chronic heart failure, chronic kidney failure, gastric ulcer	Gastric ulcer, acute kidney failure, gastrointestinal bleeding	May be useful in case of cutaneous or joint involvement in case of contraindication to major immunosuppressants

Abbreviations: FVC: forced vital capacity; JAKi: Janus kinase inhibitor; MTX: methotrexate; TPMT: thiopurine S methyl transferase.

Table 4 Ongoing Trials for Sarcoidosis

Indication	Molecule on Trial	Measured Outcomes	Phase	NCT	Control	Advancement
Cardiac sarcoidosis (CHASM-CS-RCT)	Methotrexate + prednisone: Methotrexate 15–20 mg orally, SC, or IM once a week for 6 months + prednisone 20 mg daily for one month then 10 mg po daily for one month then 5 mg daily for one month and then stop. Also, Folic Acid 2 mg daily for 6 months.	Summed perfusion rest score (SPRS) on FDG-PET scan, mortality, cardiovascular hospitalization	3	NCT03593759	Prednisone	Recruiting
Cardiac sarcoidosis	Anakinra (100 mg subcutaneous each day for 4 weeks) (MAGIC ART)	Change in c-reactive protein in participant plasma samples, change in cardiac PET, change on cardiac MRI, number of serious cardiac events	2	NCT04017936	Placebo	Not yet recruiting
Chronic pulmonary sarcoidosis	Tranilast (0.1g each time, three times a day,12 months)	Changes in the size of the pulmonary nodule by ultrasound, changes of the forced vital capacity (FVC)	1	NCT03528070	ND	Not yet recruiting
Chronic pulmonary sarcoidosis with fibrosis	Roflumilast	Reduction in number of episodes of acute exacerbation, change in FVC, change in quality of life	4	NCT01830959	Placebo	Unknown status
Pulmonary sarcoidosis	Azithromycin (250 mg/d 3 months)	24h cough monitoring with ambulatory cough monitor will be performed at baseline and at 1mth and 3 months post treatment	2	NCT04020380	ND	Not yet recruiting
Progressive fibrotic pulmonary sarcoidosis	Pirfenidone 267 mg 3/d	Change in FVC and Time until clinical worsening	4	NCT03260556	Placebo	Recruiting
Pulmonary sarcoidosis	Canakinumab (300 mg subcutaneous each month for 6 months)	Change between baseline and week 24 in pulmonary function as measured by spirometry	2	NCT02888080	Placebo	Completed/not available
Corticodependent pulmonary sarcoidosis	Tofacitinib 5 mg twice a day	50% reduction in corticosteroid requirement in at least 60% of subjects	1	NCT03793439	ND	Recruiting
Pulmonary sarcoidosis (HySSAS)	Hydroxychloroquine + prednisone (Hydroxychloroquine per os 200 mg/die (or adjusted for body weight if less than 61 kg), twice/day + prednisone 0.15 mg/kg per os daily, once/day for 3 months, than for further 6 months between responders).	The primary efficacy measure is the per-subject overall success rate at the 3-month visit	3	NCT02200146	Prednisone	completed without results posted
Chronic pulmonary sarcoidosis (ACPS)	Acthar Gel (ACTH) 80 or 40 units ACTHAR gel will be given twice a week for 22 weeks after initial loading	Cumulative toxicity between two arms of study over 24 weeks of study This will be assessed using a steroid toxicity questionnaire	4	NCT02188017	ND	Unknown status
Chronic pulmonary sarcoidosis	Acthar Gel (ACTH) 80 units twice weekly	Assessment of sarcoidosis treatment score	4	NCT03320070	Placebo	Recruiting
Cutaneous sarcoidosis	Tofacitinib 5 mg twice a day	Change in Cutaneous Sarcoidosis Activity and Morphology Instrument	ND	NCT03910543	ND	Recruiting
Cutaneous sarcoidosis	Acthar Gel (ACTH) 40 or 80 units twice weekly (phase2/phase 3)	The change in SASI induration & erythema score	3	NCT02348905	ND	Unknown status
Central nervous system sarcoidosis	Acthar Gel (ACTH) Injection, 80 U daily for 10 days, then 80 U twice weekly for up to a total of 48 weeks on therapy	Proportion of patients with clinically significant improvement - successful glucocorticoid tapering	4	NCT02920710	ND	Recruiting
Central nervous system sarcoidosis	Acthar Gel (ACTH) 80 IU subcutaneously daily for 10 days then followed by 80 IU subcutaneously three times per week through Month 12	On MRI: change in total number of lesions and in the number and size of enhancing lesions 1, 3, 6 months and 12 months relative to baseline	4	NCT02298491	ND	Completed
Sarcoidosis and uveitis (any active uveitis)	Acthar Gel (ACTH) 80 U daily for 10 days, then 80 U twice weekly for up to a total of 24 weeks on therapy	Proportion of patients with clinically significant improvement in visual acuity	ND	NCT02725177	ND	Recruiting
Sarcoidosis and uveitis	Acthar Gel (ACTH) 40 units twice weekly injections in patients who have sarcoid uveitis	Degree of aqueous and vitreous inflammatory cells-change is being assessed by SUN score (Standardization of uveitis nomenclature)	ND	NCT03473964	ND	Recruiting
Sarcoidosis hypercalcemia	Acthar Gel (ACTH) 80 units twice a week for 12 week	Reduction of 24-hour urine calcium	3	NCT02155803	ND	Unknown status
Corticosteroid dependent sarcoidosis	Sarilumab (200 mg subcutaneous every two weeks)	flare-free survival of sarilumab-treated patients compared to placebo-treated controls	2	NCT04008069	Placebo	Not yet recruiting
Severe extrathoracic sarcoidosis (induction protocol with infliximab) EFRITES trial	Infliximab (Experimental: INFLIXIMAB 5 mg/kg D1-D15, then infliximab every 4 weeks W6-W10-W14/Placebo: placebo injection D1-D15 then infliximab 5 mg/kg W6-W8-W12-W16-W20)	Percentage of patients [Time Frame: week 6] who have a severity assessment score (ePOST score) inferior to 1 in all organs and absence of hypercalcemia at W6, whatever the corticosteroid dosage received	3	NCT03704610	Placebo	Not yet recruiting
Efficacy of remission-induction regimen (cyclophosphamide versus infliximab) for severe extrathoracic sarcoidosis	Infliximab 5 mg/kg D1-D15 and every 6 weeks, in association with low dose methotrexate (10 mg/week) Corticosteroids tapering regimen until 0.1 mg/kg/day	evaluate the efficacy of infliximab and cyclophosphamide to induce remission in sarcoidosis with extrathoracic localization and serious organ involvement or relapse with at least one first-line immunosuppressive drug	ND	Eudra CT 2015-002442-31	IV CYC	Recruiting

Abbreviations: ACTH, adrenocorticotrophin hormone; D, day; ePOST, extrapulmonary physician organ severity tool; FDG PET scan, fluoro-deoxy-glucose positron emission tomography; FVC, forced vital capacity; IV CYC, intravenous cyclophosphamide; MRI, magnetic resonance imaging; ND, no data; W, week.

Table 5 Therapeutic Management of Sarcoidosis Depending on Organ Involvement

Organ Involvement	When to Treat	First-Line Treatment	When to Use Second-Line Treatment	Second-Line Treatment	Third Line	Fourth Line	References
Lung sarcoidosis	Stage II or III with worsening respiratory symptoms, worsening of functional impairment (FVC < 65%, DLCO < 60%), progression of parenchymal abnormalities on CT (honeycombing, excavations, …), endobronchial stenosis, active stage IV	Corticosteroids 20–40 mg/d for at least 4 weeks then tapering to 5–10 mg/d (maintenance regimen) on 1–6 months. Maintain 5–10 mg/d for 1–3 months then slow tapering depending on clinical benefit	Increasing symptoms despite CS, or issues with CS tapering (if CS cannot be lowered under 10 mg/d). The clinician needs to be sure that parenchymal lesions are due to active disease (using PET-CT)	MTX 15 mg/d or more, AZA 1–2 mg/kg/d, LFN 20 mg/d	TNFi: IFN 3–5 mg/kg (IV) week 0, 2, 6 then each 4–8 weeks/ADA 40 mg (SC) each 14d, or each 7d if severe	Consider CYC, MMF, RTX, TCZ, JAKi, clinical trials	^Citation18,Citation161,Citation162
Sarcoidosis arthritis	impaired quality of life, proven arthritis	Corticosteroids 20–40 mg/d for at least 4 weeks then tapering to 5–10 mg/d (maintenance regimen) on 1–6 months. Maintain 5–10 mg/d for 1–3 months then slow tapering depending on clinical benefit	Increasing symptoms despite CS, or issues with CS tapering (if CS cannot be lowered under 10 mg/d).	HCQ, MTX, AZA, LFN	TNFi	Switch biologic (TCZ, RTX) or JAKi or clinical trial	^Citation163
Heart sarcoidosis	Proven cardiac sarcoidosis (PET CT, MRI + extracardiac granuloma or cardiac granuloma alone)	Corticosteroids max 30 mg/d and consider association with MTX in first line	Progression on MRI or PET-CT	MTX	TNFi (prefer IFX)	CYC, IVMP	^Citation82,Citation164,Citation165
Eye involvement	Anterior uveitis	Topical steroids + cycloplegics	Persistent uveitis or recurrent flares	Consider peri or intraocular CS	ND	ND
	Unilateral intermediate or posterior uveitis without complications	Consider peri or intra ocular CS	Persistent uveitis	(± IVMP) + systemic CS 1 mg/kg/d for 3 to 6 weeks	If CS > 7 mg/d or unacceptable CS side effects, consider MTX or AZA	TNFi, MMF or LFN. If failure, consider RTX, TCZ or clinical trial	^Citation49,Citation62,Citation166,Citation167
	Severe intermediate or posterior uveitis with ON or ME or ORV or both eye involvement	(± IVMP) + systemic CS 1 mg/kg/d for 3 to 6 weeks	CS > 7 mg/d or unacceptable side effects of CS	MTX or AZA	TNFi, MMF or LFN	If failure, consider TCZ or JAKi
Skin involvement	Lupus pernio	Localized cutaneous sarcoidosis		Extended cutaneous disease or esthetic/functional threatening skin sarcoidosis
	Intralesional triamcinolone, DXC, HCQ, TNFi, TLD	Non-severe lesions	Severe lesions (thick, major extension, inflammatory)	First line	Second line	Third line	^Citation48,Citation129,Citation130,Citation145,Citation150,Citation168,Citation169
	Topical CS can be used. If systemic treatment needed, prefer HCQ, DXC, MTX, TLD. If refractory, TNFi or JAKi may be used	Topical treatments (dermocorticoids, topical tacrolimus, topical retinoids)	Intralesional triamcinolone (thick plaques), laser, dynamic phototherapy	Consider systemic therapy (prefer HCQ, DXC, MTX, TDM)	Consider other drugs before IS: systemic CS, pentoxifylline, apremilast, acitretin	Consider TNFi. JAKi may be considered
Naso pharyngeal involvement	Disturbing symptoms, cartilage perforation, …	Local CS can be used but systemic CS are often needed	Refractory disease or unacceptable side effects or contra indication to CS	Consider HCQ, MTX, AZA	Consider TNFi	Other IS (CYC), clinical trials, …	^Citation170
Neurosarcoidosis	Almost always warranted	CS (1 mg/kg) ± IVMP (short regimen for facial palsies)	Refractory disease or unacceptable side effects or contra indication to high dose CS	MTX, AZA, LFN, MMF	Consider TNFi (IFX)	Switch TNFi (ADA) or CYC, RTX, RCI, radiation therapy, clinical trials …	^Citation52,Citation71,Citation171
Renal sarcoidosis	Hypercalcemia and hypercalciuria	CS 0.3–0,5 mg/kg then tapering to 5–10 mg/d (12 months)	Persistent hypercalcemia	HCQ, CQ	Ketoconazole (600–800 mg/d)	ND
	Renal failure	CS 0.5–1 mg/kg/d (IVMP is useless) with slow tapering over 18–24 months	Refractory disease or unacceptable side effects or contra indication to high dose CS	AZA, MMF (avoid MTX in acute kidney injury)	ND	ND	^Citation45,Citation56,Citation172

Abbreviations: ADA, adalimumab; AZA, azathioprine; CS, corticosteroids; CT, computed tomography; CYC, cyclophosphamide; DLCO, diffusing capacity of the lung for carbon monoxide; DXC, doxycycline; FVC, forced vital capacity; HCQ, hydroxychloroquine; IFX, infliximab; IS, immunosuppressants; IV, intravenous; IVMP, intravenous methylprednisolone pulse; JAKi, Janus kinase inhibitor; LFN, leflunomide; MMF, mycophenolate mofetil; MRI, magnetic resonance imaging; MTX, methotrexate; PET, positron emission tomography; RTX, rituximab; SC, subcutaneous; TCZ, tocilizumab; TLD, thalidomide; TNFi, tumor necrosis factor alpha inhibitor.

Korsten P, Strohmayer K, Baughman RP, Sweiss NJ. Refractory pulmonary sarcoidosis: proposal of a definition and recommendations for the diagnostic and therapeutic approach. Clin Pulm Med. 2016;23(2):67–75. doi:10.1097/CPM.0000000000000136

 PubMedGoogle Scholar

Spagnolo P, Rossi G, Trisolini R, Sverzellati N, Baughman RP, Wells AU. Pulmonary sarcoidosis. Lancet Respir Med. 2018;6(5):389–402. doi:10.1016/S2213-2600(18)30064-X

 PubMed Web of Science ®Google Scholar

Nunes H, Soler P, Valeyre D. Pulmonary sarcoidosis. Allergy. 2005;60(5):565–582. doi:10.1111/j.1398-9995.2005.00778.x

 PubMed Web of Science ®Google Scholar

Sweiss N, Patterson K, Sawaqed R, et al. Rheumatologic manifestations of sarcoidosis. Semin Respir Crit Care Med. 2010;31(04):463–473. doi:10.1055/s-0030-1262214

 PubMed Web of Science ®Google Scholar

Chapelon-Abric C, Sene D, Saadoun D, et al. Cardiac sarcoidosis: diagnosis, therapeutic management and prognostic factors. Arch Cardiovasc Dis. 2017;110(8–9):456–465. doi:10.1016/j.acvd.2016.12.014

 PubMed Web of Science ®Google Scholar

Cohen Aubart F, Nunes H, Mathian A, et al. Sarcoïdose cardiaque: avancées diagnostiques et thérapeutiques. La Revue de Médecine Interne. 2017;38(1):28–35. doi:10.1016/j.revmed.2016.03.003

 PubMed Web of Science ®Google Scholar

Birnie D, Beanlands RSB, Nery P, et al. Cardiac Sarcoidosis multi-center randomized controlled trial (CHASM CS- RCT). Am Heart J. 2020;220:246–252. doi:10.1016/j.ahj.2019.10.003

 PubMed Web of Science ®Google Scholar

Yang SJ, Salek S, Rosenbaum JT. Ocular sarcoidosis: new diagnostic modalities and treatment. Curr Opin Pulm Med. 2017;23(5):458–467. doi:10.1097/MCP.0000000000000409

 PubMed Web of Science ®Google Scholar

Matsou A, Tsaousis KT. Management of chronic ocular sarcoidosis: challenges and solutions. OPTH. 2018;12:519–532. doi:10.2147/OPTH.S128949

 Web of Science ®Google Scholar

Groen F, Rothova A. Ocular involvement in sarcoidosis. Semin Respir Crit Care Med. 2017;38(04):514–522. doi:10.1055/s-0037-1602382

 PubMed Web of Science ®Google Scholar

Sève P, Jamilloux Y, Tilikete C, Gerfaud-Valentin M, Kodjikian L, El Jammal T. Ocular sarcoidosis. Semin Respir Crit Care Med. 2020.

 PubMed Web of Science ®Google Scholar

Noe MH, Rosenbach M. Cutaneous sarcoidosis. Curr Opin Pulm Med. 2017;23(5):482–486. doi:10.1097/MCP.0000000000000402

 PubMed Web of Science ®Google Scholar

Damsky W, Thakral D, McGeary MK, Leventhal J, Galan A, King B. Janus kinase inhibition induces disease remission in cutaneous sarcoidosis and granuloma annulare. J Am Acad Dermatol. 2019. doi:10.1016/j.jaad.2019.05.098

 Web of Science ®Google Scholar

Wei JJ, Kallenbach LR, Kreider M, Leung TH, Rosenbach M. Resolution of cutaneous sarcoidosis after Janus kinase inhibitor therapy for concomitant polycythemia vera. JAAD Case Rep. 2019;5(4):360–361. doi:10.1016/j.jdcr.2019.02.006

 PubMedGoogle Scholar

Baughman RP. Efficacy and safety of apremilast in chronic cutaneous sarcoidosis. Arch Dermatol. 2012;148(2):262. doi:10.1001/archdermatol.2011.301

 PubMedGoogle Scholar

Drake WP, Oswald-Richter K, Richmond BW, et al. Oral antimycobacterial therapy in chronic cutaneous sarcoidosis: a randomized, single-masked, placebo-controlled study. JAMA Dermatol. 2013;149(9):1040. doi:10.1001/jamadermatol.2013.4646

 PubMed Web of Science ®Google Scholar

Dai C, Shih S, Ansari A, Kwak Y, Sami N. Biologic therapy in the treatment of cutaneous sarcoidosis: a literature review. Am J Clin Dermatol. 2019;20(3):409–422. doi:10.1007/s40257-019-00428-8

 PubMed Web of Science ®Google Scholar

Wanat KA, Rosenbach M. Cutaneous sarcoidosis. Clin Chest Med. 2015;36(4):685–702. doi:10.1016/j.ccm.2015.08.010

 PubMed Web of Science ®Google Scholar

Edriss H, Kelley JS, Demke J, Nugent K. Sinonasal and laryngeal sarcoidosis—an uncommon presentation and management challenge. Am J Med Sci. 2019;357(2):93–102. doi:10.1016/j.amjms.2018.11.007

 PubMed Web of Science ®Google Scholar

Bitoun S, Bouvry D, Borie R, et al. Treatment of neurosarcoidosis: a comparative study of methotrexate and mycophenolate mofetil. Neurology. 2016;87(24):2517–2521. doi:10.1212/WNL.0000000000003431

 PubMed Web of Science ®Google Scholar

Fritz D, van de Beek D, Brouwer MC. Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis. BMC Neurol. 2016;16(1):220. doi:10.1186/s12883-016-0741-x

 PubMed Web of Science ®Google Scholar

Voortman M, Drent M, Baughman RP. Management of neurosarcoidosis: a clinical challenge. Curr Opin Neurol. 2019;32(3):475–483. doi:10.1097/WCO.0000000000000684

 PubMed Web of Science ®Google Scholar

Mahévas M, Lescure FX, Boffa -J-J, et al. Renal Sarcoidosis: clinical, Laboratory, and Histologic Presentation and Outcome in 47 Patients. Medicine. 2009;88(2):98–106. doi:10.1097/MD.0b013e31819de50f

 PubMed Web of Science ®Google Scholar

Hilderson I, Van Laecke S, Wauters A, Donck J. Treatment of renal sarcoidosis: is there a guideline? Overview of the different treatment options. Nephrol Dialysis Transplant. 2014;29(10):1841–1847. doi:10.1093/ndt/gft442

 PubMed Web of Science ®Google Scholar

Mahevas M, Simon T, Audard V, et al. Résultats de l’étude Corticoïdose. Étude prospective multicentrique randomisée comparant l’efficacité et la tolérance des bolus de méthylprednisolone dans la sarcoïdose rénale. La Revue de Médecine Interne. 2017;38:A43. doi:10.1016/j.revmed.2017.10.308

 Google Scholar