Adverse long-term effect of corticosteroid therapy in recent-onset sarcoidosis

The indications for corticosteroid therapy (CST) in persons with pulmonary (stages II-IV) sarcoidosis lacking compelling symptoms are undefined. Some studies have demonstrated a long-term adverse outcome in treated individuals in comparison with controls. The objectives of this analysis are: 1) to seek corroborative evidence for an adverse long-term effect of CST in pulmonary sarcoidosis; 2) to determine which individuals are at risk; and 3) to provide evidence-based guides for CST in pulmonary sarcoidosis.

I summarized and stratified according to disease duration all CST trials of pulmonary sarcoidosis providing long-term follow-up, published in the English language, identified in the MEDLINE database, 1966-2001, employing the search term "sarcoidosis AND therapy trials," and in a review of bibliographies of retrieved articles.

Three competent concurrent controlled CST trials and two non-concurrent controlled trials in young persons with recently diagnosed stage II-III sarcoidosis showed that, long-term, those allocated for treatment were more than twice as likely as untreated subjects to exhibit radiographic or clinical progression or death. In controlled trials in patients with disease of intermediate duration, the effect of universal vs. selective provision of CST varied from neutral to slightly beneficial. Patients with progressive chronic sarcoidosis either improved or stabilized, intermediate term, in response to CST.

CST in persons with recent onset sarcoidosis is more likely to result in long-term harm than benefit; in persons with sarcoidosis of intermediate duration, its effect is close to neutral; persons with progressive chronic pulmonary sarcoidosis respond favorably intermediate-term.