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Treating sarcoidosis: when less is more
Niamh Logan1, Jessica Raja1, Elisabetta A Renzoni2
1Department of Interstitial Lung Diseases, Royal Brompton Hospital, Dovehouse St, London SW36JY, UK.
Current Opinion in Immunology
|October 14, 2025
Summary
Sarcoidosis management is shifting from prolonged high-dose steroids to a
Area of Science:
- Immunology
- Rheumatology
- Neurology
Background:
- Sarcoidosis presents heterogeneously, ranging from spontaneous remission to disabling symptoms like neuropathy and fatigue.
- Organ- or life-threatening sarcoidosis requires disease-modifying therapies.
- Traditional glucocorticoid use is challenged by toxicity concerns.
Purpose of the Study:
- To review current sarcoidosis treatment strategies.
- To highlight the paradigm shift towards reduced steroid use.
- To discuss alternative and symptom-based management approaches.
Main Methods:
- Literature review of current sarcoidosis treatment.
- Analysis of recent clinical trial data.
- Focus on glucocorticoid-sparing strategies.
Main Results:
- Methotrexate shows comparable efficacy to glucocorticoids in pulmonary sarcoidosis, albeit with delayed effect.
- Evidence of glucocorticoid-related toxicities is increasing.
- A 'less is more' approach is gaining traction.
Conclusions:
- Treatment strategies are evolving to minimize steroid toxicity.
- Symptom-based management is crucial for non-responsive presentations.
- Future sarcoidosis treatment emphasizes tailored, less toxic approaches.
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