- The primary treatment goal in sarcoidosis is to stop the inflammation which damages the body’s organ. This is done with medications called “immunosuppressants”. Because these medicines suppress the immune system, it leaves patients more vulnerable to certain kinds of infections. Depending on the medications used, there are other side-effects which may occur as well. Therefore, the overall goal in treating sarcoidosis is to suppress the inflammation – but to do so using medications with the least risk possible. Common medications used include:
Steroids: These medications have the longest track-record for treating sarcoidosis, and have the advantage of acting quickly and (sometimes) most effectively to calm the inflammation. The most commonly used steroid is called prednisone. Steroids are often used at the time of initial diagnosis, or when there is a disease flare, for this reason. However, steroids can have significant side-effects, including weight gain, elevated blood sugar, decreased bone density, and insomnia – so the goal is typically to treat patients long term with either no steroids or a low maintenance dose.
Steroid-sparing agents: These medications often aren’t as strong as steroids, but can have the advantage of having fewer long-term side-effects. The most common steroid-sparing agent used is called methotrexate, though others such as azathioprine or hydroxychloroquine can be used as well. Most of the time, a steroid-sparing agent will be started early after diagnosis, with a goal to use it for long-term disease control as the steroids are weaned. These medications usually require periodic laboratory monitoring for safety.
TNF (Tumor Necrosis Factor) inhibitors: This class of steroid-sparing medication come in intravenous or injectable forms, and are often used if inflammation cannot be well-controlled with steroids, or if a patient would otherwise require high long-term doses of steroids to control the disease. Most commonly, this medication is prescribed by a Rheumatologist.
Prophylactic medications: For patients taking methotrexate, the vitamin folic acid is usually prescribed to help minimize side-effects. Depending on the doses of other immune-suppressing medications, you may be prescribed an antibiotic to help prevent certain kinds of infection.