This narrative review summarizes recent clinical practice guidelines on the treatment of pulmonary sarcoidosis, as well as mechanistic and clinical data supporting repository corticotropin injection (RCI) as a safe and effective treatment option.

Multiple therapeutic options exist, including methotrexate, azathioprine, leflunomide, mycophenolate, and infliximab; however, only corticosteroids and RCI are approved by the US Food and Drug Administration for the treatment of sarcoidosis.

RCI uniquely binds and activates melanocortin receptors on adrenocortical cells and various types of immune cells to promote anti-inflammatory and immunomodulatory effects.

RCI is steroid-sparing for patients with sarcoidosis, most of whom reduced their steroid dosages by > 50% in three clinical trials, and has been shown to be safe and effective for treatment of sarcoidosis that was nonresponsive to corticosteroids.

A recent expert panel using a modified Delphi process found that RCI is most commonly used in clinical practice as a second-line treatment for sarcoidosis after steroids, while European Respiratory Society (ERS) guidelines recommend that RCI be used on a case-by-case basis.