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Am Fam Physician. 2005;72(9):1702-1703

Clinical Question

Do inhaled or oral corticosteroids improve outcomes for patients with pulmonary sarcoidosis?

Evidence-Based Answer

Patients who take oral corticosteroids are more likely to show improvement in their chest radiographs than those taking placebo, although improvements in symptoms and lung function are less certain. The typical dosage used in randomized trials was 20 mg daily or 40 mg every two days tapered over several months.

Practice Pointers

Sarcoidosis is a multisystem disease that often affects the lungs. Pulmonary sarcoidosis is characterized by cough, breathlessness, and progressive respiratory failure. Corticosteroids are the most widely used treatment, but until now, the evidence had not been reviewed systematically. Other treatments, such as methotrexate, antimalarial drugs, cyclosporine (Sandimmune), and the immunomodulator infliximab (Remicade), have been less well studied.1

Paramothayan and associates found 12 randomized controlled trials using different doses and routes of administering corticosteroids. Only two were double-blinded, and only two used adequate concealment of allocation. The 1,051 participants involved in the studies were at various stages of histology-confirmed disease. The studies used a variety of outcomes, primarily symptoms, lung function, and chest radiograph findings. Few data were available for more than two years of follow-up, and none of the studies measured the impact on mortality. In general, studies were small, most with fewer than 50 participants.

Four studies compared oral steroids with placebo, and two compared oral steroids with no treatment. Of the two largest studies, one used a tapering dose of 20 to 10 mg daily and the other a tapering dose of 40 to 20 mg every two days. The researchers found a consistent benefit in terms of improved chest radiograph appearance at the end of follow-up (70 versus 49 percent, P = .04, number needed to treat = 5). However, they found no consistent evidence of symptomatic improvement or improvement in measures of lung function. Comparisons of inhaled steroids with placebo did not show any consistent benefit.

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