Which nonsteroidal agents are used in the treatment of sarcoidosis?

Updated: Sep 15, 2020
  • Author: Nader Kamangar, MD, FACP, FCCP, FCCM; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Methotrexate (MTX) has been a successful alternative to prednisone and is a steroid-sparing agent. [62]

Chloroquine and hydroxychloroquine are antimalarial drugs with immunomodulating properties, which have been used for cutaneous lesions, hypercalcemia, neurological sarcoidosis, and bone lesions. Chloroquine has also been shown to be efficacious for the treatment and maintenance of chronic pulmonary sarcoidosis. [3, 4]

Cyclophosphamide has been rarely used with modest success as a steroid-sparing treatment in patients with refractory sarcoidosis. [5, 6]

Azathioprine is another second-line therapy, which is best used as a steroid-sparing agent rather than as a single-drug treatment for sarcoidosis. [7]

Chlorambucil is an alkylating agent that may be beneficial in patients with progressive disease unresponsive to corticosteroids. [8]

Cyclosporine is a fungal cyclic polypeptide with lymphocyte-suppressive properties and may be of limited benefit in skin sarcoidosis or in progressive sarcoidosis resistant to conventional therapy. [9]

Infliximab [10, 11] and thalidomide [12, 13] have also been used for refractory sarcoidosis, particularly for cutaneous disease. Infliximab appears to be an effective treatment for patients with systemic manifestations such as lupus pernio, uveitis, hepatic sarcoidosis, and neurosarcoidosis.

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