Therapeutic Responses and 6-month Clinical Outcomes in Sarcoidosis: A Longitudinal Study in a Tertiary South Indian Cohort

A BSTRACT Background: Sarcoidosis is a chronic granulomatous disorder of unknown etiology, believed to result from an immune-mediated inflammatory response to unidentified triggers. Corticosteroids remain the mainstay of treatment, while steroid-sparing agents such as methotrexate, azathioprine, leflunomide, and mycophenolate are used in refractory disease, steroid toxicity, or inability to taper steroids. This study aimed to evaluate the roles of clinicoradiological, serological, and histopathological parameters in the diagnosis of sarcoidosis and to assess treatment outcomes after 6 months. Materials and Methods: This longitudinal cohort study included 30 patients with pulmonary sarcoidosis presenting to the Department of Respiratory Medicine between March 2022 and February 2023. Treatment was based on symptom status. Symptomatic patients received systemic corticosteroids as first-line therapy, while methotrexate was used as second-line treatment in nonresponders. Results: Treatment response decreased with increasing Modified Medical Research Council dyspnea grade, from 100% response in grades 0–1 to 50% in grade 3 disease. Patients with extrapulmonary involvement had significantly poorer response rates (33.3%, P = 0.005). Radiological stage also influenced outcomes, with 100% response in stage 0–1 disease, declining to no response in stage IV disease. High-resolution computed tomography findings, such as fibrosis and consolidation, were associated with poorer response compared to nodules, septal thickening, and mediastinal lymphadenopathy. Conclusion: Early-stage pulmonary sarcoidosis showed a favorable response to corticosteroid therapy, whereas advanced disease and extrapulmonary involvement were associated with poorer outcomes. A multidisciplinary approach is essential for optimal management.