Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht.
ILD Center of Excellence, Department of Respiratory Medicine, St. Antonius Hospital, Nieuwegein.
Curr Opin Pulm Med. 2022 Sep 1;28(5):468-477. doi: 10.1097/MCP.0000000000000889. Epub 2022 Jul 18.
Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology with a wide range of highly variable clinical manifestations and unpredictable disease course. Sarcoidosis patients may present with specific organ-related symptoms involving functional impairments, and less specific symptoms. The decision whether and when to treat a sarcoidosis patient with pharmacotherapy depends on two major factors: risk of organ failure and/or death and impairment of quality of life. This decision is complex and not standardized.
Glucocorticoids (GCs) are recommended as initial treatment, when needed. Subsequent GC-sparing alternatives frequently follow. Comorbidities or adverse drug reactions (ADRs) from drugs used in sarcoidosis treatment are sometimes very hard to differentiate from symptoms associated with the disease itself, which may cause diagnostic dilemmas. An ideal approach to minimalize ADRs would involve genetic screening prior to prescribing certain 'high-risk drugs' and therapeutic drug monitoring during treatment. Pharmacogenomic testing aims to guide appropriate selection of medicines, with the potential of reducing unnecessary polypharmacy while improving clinical outcomes.
A multidisciplinary approach to the management of sarcoidosis may avoid unnecessary ADRs. It is important to consider the possibility of drug-induced damage in sarcoidosis, especially if the clinical situation deteriorates after the introduction of a particular drug.
结节病是一种病因不明的慢性多系统炎症性疾病，临床表现高度多样，且疾病进程不可预测。结节病患者可能表现为特定器官相关症状，伴有功能障碍，或表现为不那么特异的症状。是否以及何时对结节病患者进行药物治疗取决于两个主要因素：器官衰竭和/或死亡风险以及生活质量受损。这一决策较为复杂，尚无标准。
糖皮质激素（GCs）被推荐作为初始治疗，在有需要时使用。随后通常会使用其他可减少 GC 使用的药物。治疗结节病所用药物的合并症或药物不良反应（ADRs）有时很难与疾病本身相关的症状区分，这可能会导致诊断上的困境。一种理想的方法是在开具某些“高风险药物”之前进行遗传筛查，并在治疗过程中进行治疗药物监测，以尽量减少 ADRs。药物基因组学检测旨在指导合理选择药物，有可能在改善临床结局的同时减少不必要的联合用药。
多学科方法管理结节病可避免不必要的 ADRs。在结节病中，考虑药物引起的损伤很重要，尤其是在引入特定药物后临床情况恶化的情况下。
