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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Specialty

Surgery

Advisor

Thomas P. Colletti, DHSc, MPAS, PA-C

Abstract

The purpose of this article is to review pulmonary sarcoidosis disease, the treatment of pulmonary sarcoidosis, and provide alternative treatment options with disease refractory to oral glucocorticoids pharmacotherapy such as prednisone. The progression of sarcoidosis despite adequate therapy with glucocorticoids is considered to have refractory disease. Refractory sarcoidosis includes pulmonary fibrosis that leads to increased mortality. Patients who are unable to tolerate glucocorticoids due to side effects and patients with refractory or complicated cases are treated with glucocorticoid-sparing agents or Disease-Modifying anti sarcoid drugs (DMASDs) such as methotrexate, azathioprine, and leflunomide (LFE). If second-line agents, alone or in combination with glucocorticoids, are not effective, then the next treatment options are Tumor Necrosis Factor-alpha (TNF-a) antagonists such as infliximab or adalimumab. The first line, second-line, and alternative therapy approach help clinicians decide which one is the best treatment option available in the setting of adverse effects, drug toxicity, or chronic disease management and which would offer the best outcome in symptomatic progressive and disabling respiratory complications due to sarcoidosis. Pulmonary treatment approaches should tend to follow a plan that makes an appropriate assessment of whether the patient has sufficient symptomology (cough, dyspnea), pulmonary function impairment, and the extent of compromised lung function to warrant therapy.

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