Update on bioagent therapy in sarcoidosis.

Corticosteroids are still the cornerstone of treatment for patients with sarcoidosis requiring systemic therapy. However, alternative agents and especially methotrexate may be considered for patients with refractory disease or requiring prolonged treatment with intolerable side effects. Although bioagent therapies have hitherto not clearly demonstrated superior efficacy and safety over corticosteroids in pulmonary sarcoidosis, infliximab may modestly improve lung function in patients with active disease resistant to steroids. Further studies will be needed to assess both safety and efficacy of infliximab in pulmonary sarcoidosis. Infliximab may be considered in a limited number of patients with severe extrapulmonary systemic manifestations of sarcoidosis, with careful individual evaluation of the risk-benefit ratio.