Established and experimental medical therapy of pulmonary sarcoidosis

Abstract

The treatment options for pulmonary sarcoidosis have increased over the past 10 years. As new treatments have been introduced, the best way to assess and compare treatments remains unknown. The goal of this review is to discuss the standard treatments for pulmonary sarcoidosis, including glucocorticoids, and cytotoxic agents, such as methotrexate, azathioprine and leflunomide, and compare them to the newer biological agents, such as infliximab and adalimumab. We also discuss some novel treatments which are currently being evaluated. To compare these different regimens, we look at the measures used to assess response. These include pulmonary function, chest imaging, steroid sparing potential and, more recently, improvements in quality of life measures. While there is, as yet, no standard assessment for response, there is a growing consensus that response to treatment may include improvement of one or more of the following: forced vital capacity, chest imaging and steroid sparing. Several drugs used for pulmonary sarcoidosis have demonstrated improvement in one or more of these measures.

Safety and efficacy of ustekinumab or golimumab in patients with chronic sarcoidosis

“…The standard of care is oral corticosteroids (OCS), which has been shown to stabilise or improve the disease, although relapse commonly occurs once OCS therapy is tapered or discontinued [6]. Alternatives, such as antimalarial, cytotoxic, and biological agents, have shown variable efficacy [7], although treatment with these agents has also been associated with a relapse upon discontinuation, toxicity, and/or potentially serious adverse effects [1,8]. There is a substantial need for safer and more effective therapies for sarcoidosis.…”

Sarcoidosis pulmonar e hiliar: Presentación de un caso y revisión del tema

“…(8) Específicamente en relación a la sarcoidosis pulmonar el tratamiento dependerá de si el paciente tiene disnea o si tiene manifestaciones extrapulmonares que requieren tratamiento, como lo es el caso de sarcoidosis ocular, cardíaca y neurológica. (9) El síndrome de Lofgren puede manejarse con AINES para el alivio de los síntomas primarios. (9) Dada la alta tasa de remision espontánea a los 2-3 años (cercana al 70%), los pacientes asintomaticos con estadio 1 usualmente no se tratan o si se presenatn asintomáticos con pruebas de función pulmonar normales en estadio II-III.…”

“…(9) El síndrome de Lofgren puede manejarse con AINES para el alivio de los síntomas primarios. (9) Dada la alta tasa de remision espontánea a los 2-3 años (cercana al 70%), los pacientes asintomaticos con estadio 1 usualmente no se tratan o si se presenatn asintomáticos con pruebas de función pulmonar normales en estadio II-III. (10) En la sarcoidosis pulmonar, puede necesitarse prednisona, a dosis de 20 a 40 mg diarios.…”

“…Se analiza si el Golimumab a dosis altas pudiera considerarse en el tratamiento de la enfermedad pulmonar. (9) El uso off label de Rituximab puede considerarse en caso de sarcoidosis refractaria. (8) BIBLIOGRAFÍA…”

Negative clinical trials in sarcoidosis: failed therapies or flawed study design?

“…Additional therapies are greatly needed in sarcoidosis that are effective, have a reasonable safety profile and can reduce or replace the need for long-term corticosteroid therapy in those with chronic sarcoidosis who experience the inevitable development of corticosteroid toxicities [20]. If the current study design is widely adopted, the sarcoidosis community faces the prospect of more negative studies regardless of therapeutic promise.…”