Table 2.

Treatment recommendations for non-steroidal and biological agents

Agent	Starting dose (maximum dose)	Comments	Level of evidence
Disease-modifying anti-sarcoid drugs
Methotrexate	5–15 mg/week SC/PO (25 mg/week)	Liver and renal insufficieny Use of folic acid (at least 5 mg/week PO) recommended CBC, LFT and Creatinine Risk of hypersensitivity pneumonitis probably <5%	1B
Azathioprine	1 mg/kg/d (two divided doses) PO 2 mg/kg/d	Mutations of TPMT CBC, LFT Co-medication with allopurinol contraindicated	2B
Leflunomide	10–20 mg/d PO	CBC, LFT Lung toxicity reported within first 3 months Silent liver fibrosis	2B
Hydroxychloroquine / Chloroquine	5–7 mg/kg/d PO	Retinopathy (ophthalmologic examination) Cardiomyopathy	2B
Mycophenolate mofetil	500 mg/d PO (2–3 g/d)	CBC, LFT Diarrhea most common adverse effect	2C
Biological agents
Infliximab	3–5 mg/kg IV week 0,2,6 and every 4–8 weeks thereafter	Tuberculosis screening Infections Autoimmunity Hepatitis reactivation CBC, LFT	1A
Adalimumab	40 mg SC every other week (40 mg SC every week)		2B
Rituximab	1 g IV d 0 and 14	Infections Hepatitis reactivation Test serum immunoglobulins every 3 months Progressive multifocal leukencephalopathy reported	2B

Abbreviations used: CBC, complete blood count; IV, intravenously; LFT, liver function test; PO, per os; SC, subcutaneously; TPMT, thiopurine methyltransferase

Level of evidence: A: at least one double-blind placebo-controlled randomized trial with positive results with one or more case series supporting the results; level B: majority of the case series showing positive results; level C: case series with mixed reports of effectiveness or only a small number of case reports. Recommendations are further differentiated into strong (1A, 1B, 1C) or weak (2A, 2B, 2C).