Drug-induced comorbidities in patients with sarcoidosis

Abstract

Purpose of reviewSarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology with a wide range of highly variable clinical manifestations and unpredictable disease course. Sarcoidosis patients may present with specific organ-related symptoms involving functional impairments, and less specific symptoms. The decision whether and when to treat a sarcoidosis patient with pharmacotherapy depends on two major factors: risk of organ failure and/or death and impairment of quality of life. This decision is complex and not standardized.Recent findingsGlucocorticoids (GCs) are recommended as initial treatment, when needed. Subsequent GC-sparing alternatives frequently follow. Comorbidities or adverse drug reactions (ADRs) from drugs used in sarcoidosis treatment are sometimes very hard to differentiate from symptoms associated with the disease itself, which may cause diagnostic dilemmas. An ideal approach to minimalize ADRs would involve genetic screening prior to prescribing certain ‘high-risk drugs’ and therapeutic drug monitoring during treatment. Pharmacogenomic testing aims to guide appropriate selection of medicines, with the potential of reducing unnecessary polypharmacy while improving clinical outcomes.SummaryA multidisciplinary approach to the management of sarcoidosis may avoid unnecessary ADRs. It is important to consider the possibility of drug-induced damage in sarcoidosis, especially if the clinical situation deteriorates after the introduction of a particular drug.

The Overlap of Kidney Failure in Extrapulmonary Sarcoidosis in Children—Case Report and Review of Literature

“…Renal sarcoidosis after kidney transplantation is rare, usually follows a mild clinical course and is responsive to increased immunosuppression. It has been recently reported that it is safe to perform renal transplantation in sarcoidosis with close clinical and histological monitoring [ 76 ].…”

Sarcoidosis and frailty: recognizing factors that foster holistic resilience

“…physical well-being (Table 4), covers an organ-based approach outlined in prior publications [3,9 ▪▪ ], which accounts for general and sarcoidosis-related health concerns, for example preventive health, concomitant and intercurrent health conditions, as well as sarcoidosis-related disease, complications and symptom management and drug-induced morbidities [3,6 ▪▪ ,9 ▪▪ ,40 ▪▪ ,41 ▪▪ ].…”

Safety of corticosteroid therapy in sarcoidosis treatment

“…Excluding osteoporosis, there are few studies regarding other musculoskeletal adverse reactions to steroids in sarcoidosis (Drent et al, 2022;Tana et al, 2022). A more common complication is represented by myopathy and avascular necrosis of bone (in particular, osteonecrosis of the femoral head).…”

“…The impact on the cardiovascular system (CVS) of immunomodulated diseases treated with prolonged steroid therapy is well-known (Pujades-Rodriguez et al, 2020;Galiuto and Volpe, 2021;Giraud et al, 2021;Melani et al, 2021;Drent et al, 2022;Tana et al, 2022).…”