Sarcoidosis: is therapy effective?

Treatment of sarcoidosis is controversial. The clinical expression and natural history of sarcoidosis is variable, and spontaneous remissions occur in up to 60% of patients. The decision to treat (or withhold treatment) is often difficult. Corticosteroids, immunosuppressive/cytotoxic, and immunomodulatory agents are used to treat chronic or progressive sarcoidosis, but prospective, randomized trials assessing efficacy of these agents are lacking. Toxicities associated with therapy may be substantial, particularly when high dosages are used. We review the pharmacologic agents used to treat sarcoidosis, toxicities associated with treatment, and appropriate use and monitoring of these therapeutic modalities.