ERS clinical practice guidelines on treatment of sarcoidosis

Robert P Baughman*, Dominique Valeyre, Peter Korsten, Alexander G Mathioudakis, Wim A Wuyts, Athol Wells, Paola Rottoli, Hiliaro Nunes, Elyse E Lower, Marc A Judson, Dominique Israel-Biet, Jan C Grutters, Marjolein Drent, Daniel A Culver, Francesco Bonella, Katerina Antoniou, Filippo Martone, Bernd Quadder, Ginger Spitzer, Blin NagavciThomy Tonia, David Rigau, Daniel R Ouellette

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

40 Citations (Web of Science)

Abstract

BACKGROUND: The major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin or other manifestations. While glucocorticoids remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. Glucocorticoid-sparing alternatives are available. The presented treatment guidelines aim to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations.

METHODS: A European Respiratory Society Task Force committee composed of clinicians, methodologists and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations.

RESULTS: The Task Force committee delivered 12 recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac and neurologic disease as well as fatigue. One PICO question regarding small-fibre neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation.

CONCLUSIONS: There are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment.

Original languageEnglish
Article number2004079
Number of pages31
JournalEuropean Respiratory Journal
Volume58
Issue number6
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Fatigue
  • Humans
  • Quality of Life
  • Sarcoidosis/diagnosis
  • CHRONIC CUTANEOUS SARCOIDOSIS
  • LONG-TERM OUTCOMES
  • SMALL FIBER NEUROPATHY
  • LATE GADOLINIUM ENHANCEMENT
  • F-18 FDG-PET/CT
  • DOSE METHOTREXATE THERAPY
  • BRITISH-THORACIC-SOCIETY
  • LEFT-VENTRICULAR DYSFUNCTION
  • QUALITY-OF-LIFE
  • PLACEBO-CONTROLLED TRIAL

Cite this