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Updated: Dec 22, 2025

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease

Published on: June 16, 2020

Refractory Sarcoidosis: A Review.

Thomas El Jammal¹, Yvan Jamilloux¹, Mathieu Gerfaud-Valentin¹

¹Department of Internal Medicine, Lyon University Hospital, Lyon, France.

Therapeutics and Clinical Risk Management

|May 6, 2020

Summary

Refractory sarcoidosis management is challenging. This review summarizes current and emerging immunosuppressant treatments for patients unresponsive to standard therapies, including corticosteroids and methotrexate.

Keywords:

JAK inhibitors anti-TNF refractory sarcoidosis

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Area of Science:

Immunology
Rheumatology
Pulmonology

Background:

Sarcoidosis is a multi-system granulomatous disease with unknown cause.
Corticosteroids are first-line, but some patients lack response or tolerance.
Refractory sarcoidosis lacks clear definition and treatment guidelines.

Purpose of the Study:

To review the current state of immunosuppressant use in refractory sarcoidosis.
To discuss management strategies for multidrug-resistant sarcoidosis.
To highlight emerging therapies and ongoing clinical trials.

Main Methods:

Literature review of immunosuppressants for refractory sarcoidosis.
Analysis of case series and clinical trial data.
Synthesis of current treatment approaches and future directions.

Main Results:

Methotrexate is the only first-line immunosuppressant with RCT validation.
Second-line immunosuppressants (e.g., methotrexate, leflunomide) are used when corticosteroids fail.
Third-line agents like TNF inhibitors are validated; others (rituximab, tocilizumab) lack RCTs in sarcoidosis.
JAK inhibitors are under investigation.

Conclusions:

Refractory sarcoidosis requires careful management beyond standard guidelines.
Further research and clinical trials are crucial for validating new immunosuppressants.
Defining non-response and optimizing treatment timing are key challenges.