Corticosteroid treatment in sarcoidosis

Abstract

At present there is no curative treatment for sarcoidosis. Immunosuppressive and/or immunomodulatory drugs can, however, be used for controlling the disease.Corticosteroids remain the mainstay of therapy. They function by suppressing the proinflammatory cytokines and chemokines that are involved in cell-mediated immune responses and granuloma formation. Only in a select group of patients is it justifiable to use these drugs, after careful evaluation of the pros and cons. Importantly, disease severity, e.g. threatened organ functions, and not disease activity itself should be the deciding factor in this process.In the case of parenchymal involvement, there is substantial evidence that corticosteroids can improve respiratory symptoms and chest radiography and lung function parameters over 6-24 months. Other generally acknowledged (empirical) criteria for systemic treatment include neurological, cardiac and sight-threatening ocular involvement and hypercalcaemia. Remarkably, despite .50 yrs of use, there is no proof of long-term (survival) benefit from corticosteroid treatment. In addition, there are still no data regarding the optimal dose and duration of corticosteroid or other immunosuppressive therapy.One of the weightiest questions remaining is whether or not these drugs can prevent scarring in patients with a fibrogenic phenotype. As new agents, including infliximab and thalidomide, enter the stage and new diagnostic tools are now available, there is clearly a momentum to design multicentric randomised controlled trials with long enough follow-up (.5 yrs) to answer this pivotal question.

Cutaneous Sarcoidosis Presenting as Multiple Erythematous Macules and Patches

“…Nonetheless, worldwide accepted standard therapies for sarcoidosis include the administration of corticosteroids, antimalarials, and methotrexate 8 . Steroids function by suppressing the pro-inflammatory cytokines and chemokines involved in cell-mediated immune responses and granuloma formation 9 .…”

The Hypercalcemic Effect of Vitamin D3 in Sarcoidosis Could Be a Side Effect of an Endogenous Program Organizing Cancer Apoptosis

“…The patient was treated with low-dose prednisolone (30 mg daily). Serum ACE decreased to normal levels, which was evaluated as a success [37].…”

Sarcoidosis: Unknown Etiology and Genetic Predisposition Provides Therapeutic Challenges

“…[1,95,96]. Corticosteroids such as Prednisolone and its precursor Prednisone inhibit inflammation through stimulation of anti-inflammatory genes, as well as through repression of inflammatory genes such as Interleukin 1, Interferon-gamma (IFN-γ) and Tumor necrosis factor (TNF)-α [97,98]. Corticosteroids can also inhibit NF-kB activity and restore potent Th1 immune responses back to a normal Th1 and Th2 balance [99][100][101].…”