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Emerging Therapeutic Options for Refractory Pulmonary Sarcoidosis: The Evidence and Proposed Mechanisms of Action
Nathaniel C Nelson1, Rebecca Kogan1, Rany Condos1
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University, 301 E 17th St Suite 550, New York, NY 10003, USA.
Abstract:
Sarcoidosis is a systemic disease with heterogenous clinical phenotypes characterized by non-necrotizing granuloma formation in affected organs. Most disease either remits spontaneously or responds to corticosteroids and second-line disease-modifying therapies. These medications are associated with numerous toxicities that can significantly impact patient quality-of-life and often limit their long-term use. Additionally, a minority of patients experience chronic, progressive disease that proves refractory to standard treatments. To date, there are limited data to guide the selection of alternative third-line medications for these patients. This review will outline the pathobiological rationale behind current and emerging therapeutic agents for refractory or drug-intolerant sarcoidosis and summarize the existing clinical evidence in support of their use.
Insights
This review explores advanced therapies for sarcoidosis patients unresponsive to standard treatments. It examines emerging options for managing refractory sarcoidosis and drug intolerance.
Area of Science:
- Immunology
- Pulmonology
- Rheumatology
Background:
- Sarcoidosis is a systemic inflammatory disease.
- Granuloma formation characterizes sarcoidosis.
- Standard treatments include corticosteroids and DMARDs.
Purpose of the Study:
- To review therapeutic agents for refractory sarcoidosis.
- To discuss emerging treatments for drug-intolerant sarcoidosis.
- To outline the pathobiological rationale for these agents.
Main Methods:
- Literature review of current and emerging therapies.
- Analysis of pathobiological mechanisms.
- Summary of clinical evidence for third-line treatments.
Main Results:
- Limited data exist for third-line sarcoidosis treatments.
- Corticosteroids and DMARDs have significant toxicities.
- A minority of patients have chronic, progressive disease.
Conclusions:
- There is a need for effective treatments for refractory sarcoidosis.
- Emerging therapies offer potential alternatives.
- Further research is needed to guide treatment selection.
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