• Hilario Nunes, Yurdagul Uzunhan, Daniel Bonnet, and Dominique Valeyre.
• Service de pneumologie, hôpital Avicenne AP-HP, université Paris-Nord 13, 93009 Bobigny cedex, France. hilario.nunes@avc.aphp.fr
• Rev Prat. 2008 May 31; 58 (10): 1099-104.

AbstractSarcoidosis treatment suppresses the granulomatous process and its clinical, functional and radiographic consequences but it is not etiological. Only a minority of patients necessitate systemic therapy. This is definitely required in severe extra-respiratory sarcoidosis including cardiac, neurological, renal, ocular involvement not responding to topical therapy and malignant hypercalcemia. Respiratory indications for therapy include symptomatic stage II/III showing significant physiologic impairment or progressive disease, and stage IV with persistent signs of activity. As a general rule, systemic corticosteroids are the first-line treatment, given for at least 12 months. One of the following sparing agents can be associated with steroids when the threshold level to control the disease is high: hydroxychloroquine, methotrexate or azathioprine. An alternative option to corticosteroids is proposed in case of contra-indication or cortico-resistant sarcoidosis; methotrexate is then the treatment of choice. Although other drugs are only occasionnally needed, the available therapeutical range is wide (thalidomide, infliximab, cyclophosphamide, leflunomide...).

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