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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
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Sarcoidosis management is shifting from prolonged high-dose steroids to a

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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.