[Hydroxychloroquine for non-severe extra-pulmonary sarcoidosis]

Area of Science:

• Rheumatology
• Immunology
• Dermatology

Background:

• Sarcoidosis is a chronic inflammatory disease affecting multiple organs.
• Corticosteroids are the primary treatment, but long-term use has side effects.
• Steroid-sparing agents are used in over one-third of patients requiring corticosteroids.

Purpose of the Study:

• To review the current evidence on steroid-sparing therapies for sarcoidosis.
• To focus on the efficacy of antimalarials, particularly hydroxychloroquine, in extra-pulmonary sarcoidosis.
• To identify the need for high-quality clinical trials.

Main Methods:

• Literature review of therapeutic trials and clinical practice regarding steroid-sparing agents in sarcoidosis.
• Analysis of the role of synthetic antimalarials, including chloroquine and hydroxychloroquine.
• Examination of evidence for treating specific sarcoidosis manifestations.

Main Results:

• Methotrexate is the most frequent steroid-sparing agent.
• Synthetic antimalarials like hydroxychloroquine have been used for decades despite limited evidence.
• Hydroxychloroquine is utilized for skin, bone, joint sarcoidosis, hypercalcemia, and uveitis.

Conclusions:

• Current evidence supporting antimalarial use in sarcoidosis is based on small trials.
• Hydroxychloroquine is widely used in practice for specific sarcoidosis forms.
• Further high-quality randomized controlled trials are essential to validate hydroxychloroquine's efficacy in sarcoidosis.