Treatment of Sarcoidosis Over the Next Decade

Sarcoidosis is an enigmatic, multisystem inflammatory disorder characterized by the formation of non-necrotizing granulomas in affected organs. Sarcoidosis may be self-limited or spontaneously resolve in up to two-thirds of individuals, but 10% to 30% develop a more chronic syndrome requiring long-term treatment. Most individuals will require treatment at some point during the course of the disease. Currently, guidelines recommend treatment in those at risk of future morbidity or organ dysfunction to preserve the quality of life. Careful identification of those likely to benefit from treatment is critical, as current agents are cumbersome to monitor and all have adverse effects. There is a lack of validated prognostic markers to identify those at risk for poor outcomes, but identifying characteristic manifestations of severe disease early can assist with treatment planning. While corticosteroids have been central to the treatment of sarcoidosis, newer data have challenged the current treatment paradigm of steroids as first-line agents. Recent and ongoing clinical trials may provide evidence for individualized approaches centered on shared decision-making with patients, as balancing the benefits of treatment must always be weighed with the potential for toxicity. This paper will provide an update on current treatment paradigms, new therapeutic strategies, and potential novel agents on the horizon while highlighting the existing challenges and barriers to progress.