Efficacy of Short-Course, Low-Dose Corticosteroid Therapy for Acute Pulmonary Sarcoidosis Exacerbations

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

“…Relapses in chronic pulmonary sarcoidosis are mostly caused by tapering below or off an effective anti-inflammatory regimen with clinically progressive granulomatous lung inflammation occurring after a time lag of weeks to months; acute bronchospasm can occur but results from the underlying progressive sarcoidosis inflammation [12][13][14]. Consistent with this observation, relapsing pulmonary sarcoidosis responds to low-dose corticosteroids typically seen in maintenance treatment responses [15]. However, relapsing pulmonary sarcoidosis is neither acute nor a true exacerbation (implying a sudden increase in granulomatous inflammation or sudden lack of response to maintenance therapy).…”

Established and experimental medical therapy of pulmonary sarcoidosis

“…In retrospective reviews, up to 14% absolute improvement in the FVC has been noted [31]. However, in placebo controlled trials, it is not clear that the response is greater than that seen with placebo [3].…”

“…The usual approach to glucocorticoid treatment is to try to taper the drug dosage to a level which will maintain the patient with stable disease [75,77]. In that situation, patients may require only short courses of increased dosage to manage episodes of deterioration [31]. However, the maintenance dosage may still be associated with significant toxicity and steroid sparing alternatives have been evaluated.…”

Updated Guidelines for the Treatment of Pulmonary Sarcoidosis

“…Even so, it is clear that there is no standardisation in the treatment of pulmonary sarcoidosis, and this is due to the lack of clinical trials. The majority of published studies are not blinded, randomised, or controlled, and involve a very small number of patients, using different doses or lengths of treatment and different endpoints (McKinzie et al, 2010). For these reasons, Schutt et al (Schutt et al, 2010) used the Delphi research technique.…”

“…In this respect, McKinzie et al (McKinzie et al, 2010) performed a retrospective study of patients with pulmonary sarcoidosis that were treated with ≤20mg of oral prednisone during exacerbations, and clinical evolution and changes in spirometry values were assessed after two weeks. This study demonstrated that these patients improved in clinical symptoms and spirometry values, although it did have some limitations: 1) the study was retrospective, implying a patient selection bias; 2) it did not follow up on long-term patient progression, and therefore, we cannot comment on the evolution of the disease; 3) the study was not designed specifically to measure the adverse effects of corticosteroid treatment; 4) it lacked a control group; 5) the two-week follow-up period was not maintained in all patients (median: 21 days).…”