Current treatment of sarcoidosis

Sarcoidosis is a systemic granulomatous disease with almost 90% of intrathoracic involvement. Therapeutic management of the disease is challenging as clinical presentation and prognosis are heterogeneous. Self-limited disease is the most common presentation; however, 10-20% of patients may develop progressive disease. Recognition of this phenotype is important as it carries a poor prognosis and a limited response to treatment. The goals of sarcoidosis therapy are to prevent or to minimize organ damage, to relieve symptoms, and to improve the patient’s quality of life. In this review, we summarized the main advances in sarcoidosis pharmacotherapy. Current available therapies for sarcoidosis include glucocorticoids, immunosuppressants, and TNF-alfa antagonists. Other agents (such as rituximab), repository corticotropin and combined antibiotic treatment may have a role in selected cases. Recent evidence shows that antifibrotic agents, such as nintedanib, have a role in fibrotic lung disease, as well as efzofitimob, which has shown promising results in controlling inflammatory lung disease. Although the number of studies of therapies for pulmonary sarcoidosis has increased in recent years, the information available is still limited and there is no consensus on how to monitor the activity of the disease.