The lung in autoimmune diseases: sarcoidosis

Baughman, Robert P.; Lower, Elyse E.

doi:10.1016/b978-0-323-91083-5.00011-6

Cited by 2 publications

(5 citation statements)

References 76 publications

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“…A significant improvement in forced vital capacity was seen and use allowed tapering of prednisone in these patients. This effect has also been shown in patients who failed methotrexate therapy in another smaller series of patients [15].…”

Section: Tablesupporting

confidence: 60%

Anti-Granulomatous Therapy for Pulmonary Sarcoidosis

K. Gerke

2024

Sarcoidosis - Diagnosis, Research, and Therapy of a Granulomatous Disease

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Sarcoidosis is a systemic disease of granulomatous inflammation that predominately affects the lungs. The cause is unknown. Although over half of cases spontaneously resolve, a large proportion of patients require therapy for progressive symptoms or worsening organ function. Corticosteroids remain first-line therapy, but steroid-sparing medications should be considered in high-risk cases. In this chapter, we review types of therapies targeted to the granulomatous inflammatory pathway and their role in treatment of sarcoidosis. Because of the complex interaction of patient factors and medication toxicities, appropriate clinical management should include a personalized discussion with each patient to determine the individual treatment plan. Future trials are needed to test novel drugs and establish less toxic approaches to therapy.

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Section: Tablesupporting

confidence: 60%

Anti-Granulomatous Therapy for Pulmonary Sarcoidosis

K. Gerke

2024

Sarcoidosis - Diagnosis, Research, and Therapy of a Granulomatous Disease

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“…The indication for therapy has been based on the presence of symptoms and biochemical liver derangement, with or without evidence of fibrosis/ cirrhosis on imaging. 9 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 The dosage of corticosteroids, particularly prednisolone, varies from 20 mg to 60 mg per day. 12 , 27 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 In our review, some of the studies used dosages of 0.5 mg to 1 mg/kg/day, 45 , 46 , 47 and none of the studies reported a prednisolone dose of greater than 1 mg/kg/day.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 The dosage of corticosteroids, particularly prednisolone, varies from 20 mg to 60 mg per day. 12 , 27 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 In our review, some of the studies used dosages of 0.5 mg to 1 mg/kg/day, 45 , 46 , 47 and none of the studies reported a prednisolone dose of greater than 1 mg/kg/day. Two review articles suggested a time frame of 4–6 weeks for initial duration of treatment, and subsequently to taper off prednisolone 5‐10 mg every 4–8 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have shown that UDCA may be effective in hepatic sarcoidosis, but mainly in patients with cholestasis or a predominant symptom of pruritus. The recommended dosage of 10 mg/kg/day used in most of the reported studies 27 , 30 , 51 , 52 demonstrated improvement in liver biochemistry and symptoms of cholestasis, particularly pruritus. 12 , 45 , 51 Although the patients included in this systematic review did not undergo repeated biopsy posttreatment, it has been suggested that UDCA does not impede histological progression of the disease.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 45 , 51 Although the patients included in this systematic review did not undergo repeated biopsy posttreatment, it has been suggested that UDCA does not impede histological progression of the disease. 9 , 27 …”

Section: Discussionmentioning

confidence: 99%

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The clinical management of hepatic sarcoidosis: A systematic review

Sinnanaidu,

Kumar,

Shunmugam

et al. 2024

JGH Open

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BackgroundHepatic sarcoidosis is an uncommon clinical condition in which clear recommendations are lacking in its treatment. We aimed to review systematically the literature on hepatic sarcoidosis treatment to guide clinicians.MethodsUsing MEDLINE, PubMed, CINAHL, Cochrane Library, and Google Scholar databases, we searched original articles on clinical studies reporting the outcome of adult hepatic sarcoidosis patients following treatment with various pharmacological agents. The primary end point was focused on assessing symptomatic relief and biochemical improvement posttreatment.ResultsOut of 614 retrieved references, 34 published studies were eligible, providing data for a total of 268 patients with hepatic sarcoidosis. First‐line therapy with corticosteroids alone was reported in 187 patients, whilst ursodeoxycholic acid (UDCA) was used in 40 patients. Symptomatic and biochemical responses were reported among 113(60.4%) and 80(42.8%) cases of corticosteroids respectively, whereas UDCA showed a complete response in 23(57.5%) patients. Second‐line therapy was used in steroid‐refractory cases, with most cases being reported for azathioprine (n = 32) and methotrexate (n = 28). Notably, 15(46.9%) and 11(39.2%) patients showed both clinical and biochemical responses respectively. Biological therapy including anti‐tumor necrosis factor (anti‐TNF) was used as third line therapy in twelve cases with a 72.7% symptomatic and biochemical response rate each.ConclusionThe quality of evidence for the treatment of hepatic sarcoidosis was poor. Nevertheless, it appears that corticosteroid or UDCA may be utilized as first‐line therapy. For cases that are refractory to corticosteroids, steroid‐sparing immunosuppressive agents and anti‐TNF have shown some promising results, but further high‐quality studies are required.

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The lung in autoimmune diseases: sarcoidosis

Cited by 2 publications

References 76 publications

Anti-Granulomatous Therapy for Pulmonary Sarcoidosis

Anti-Granulomatous Therapy for Pulmonary Sarcoidosis

The clinical management of hepatic sarcoidosis: A systematic review

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