Table 1.
Drugs for the treatment of sarcoidosis
| Organ | Manifestations | Treatment
|
|
|---|---|---|---|
| Drug of choice | Alternatives¶¶ | ||
| Lung | C | M, AZ, L, CQ, I, AD | |
| Eye | Anterior uveitis: red eye, painful eye, photophobia | CED, CP | C, M, AZ, L, I AD |
| Posterior uveitis: floaters, ↓ vision | C | M, AZ, L, I, AD | |
| Optic neuritis: sudden loss of vision or color vision | C* | M, AZ, L, I, AD | |
| Skin | Erythema nodosum: pain erythematous/violaceous lesions on extensor surface | NSAID† | C |
| Localized lesion(s) | CI, CC | C, M, AZ, L, H, CQ, MY, I, AD, TET | |
| Diffuse lesions | C | M, AZ, L, H, CQ, MY, I, AD, TET | |
| Lupus pernio: disfiguring facial sarcoidosis | C | I‡, M, AZ, L, H, CQ, MY, AD | |
| Liver | Asymptomatic LFT ↑ | Do not treat | |
| Fever, nausea, vomiting | C | M, AZ, L, H, CQ, I, AD | |
| Pruritus, cholestasis | C§ | M, AZ, L, H, CQ, I, AD | |
| Joints | Arthritis | NSAID | C, H, CQ, M, AZ, L, I, AD |
| Joint destruction | C | H, CQ, M, AZ, L, I, AD | |
| Heart | Symptomatic heart block | C||,¶ | M, L, CYC, I**, AD** |
| Symptomatic arrhythmia | C||,††,‡‡ | M, L, CYC, I**, AD** | |
| Left ventricular dysfunction | C||,††,‡‡ | M, L, CYC, I**, AD** | |
| Neurologic | Mild to moderate | C|| | M, H, CQ, MY, CYC, AD, I‡ |
| Severe (eg, seizures, coma) | C* | M, H, CQ, MY, CYC, AD, I‡ | |
| Hypercalcemia | Asymptomatic, serum calcium < 11 mg/dL | High fluid intake | C, H, CQ, I, AD |
| Asymptomatic, serum calcium ≥ 11 mg/dL | C | H, CQ, I, AD | |
| Nephrolithiasis, serum creatinine ↑ | C | H, CQ, I, AD | |
| Sinus | Nasal obstruction, epistaxis, crusting, hoarseness | C§§ | M, L, AZ, I, AD |
| Airway compromise | C|||| | M, L, AZ, I, AD | |
Notes:
increase;
decrease;
consider 0.5–1 g intravenous methylprednisolone for 3–5 days followed by 40–80 mg/day prednisone equivalent;
for associated arthritis;
may be the preferred drug after corticosteroids;
addition of ursodeoxycholate often beneficial;
consider high-dose corticosteroids: 40–80 mg prednisone daily equivalent/day;
consider pacemaker or internal defibrillator placement;
contraindicated for New York Heart Association Class III and IV heart failure;
consider internal defibrillator placement;
consider heart transplantation;
corticosteroid injection if localized;
consider surgery;
usually corticosteroid sparing: require low-dose corticosteroids.
Adapted with permission from Judson MA. The management of sarcoidosis by the primary care physician. Am J Med. 2007;120(5):403–407. © 2007 Elsevier.
Abbreviations: AD, adalimumab; AZ, azathioprine; C, corticosteroids (usually 20–40 mg prednisone equivalent/day); CC, corticosteroid creams; CED, corticosteroid eye drops; CI, corticosteroid injections; CP, cycloplegics; CQ, chloroquine; CYC, cyclophosphamide; H, hydroxychloroquine; I, infliximab; L, leflunomide; LFT, liver function tests; M, methotrexate; MY, mycophenolate; NSAID, nonsteroidal anti-inflammatory drugs; TET, tetracycline drugs.