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Corticosteroids, such as prednisone and prednisolone, are the mainstay of treatment of sarcoidosis. Corticosteroid treatment usually results in improvement. Symptoms often start up again, however, when it is discontinued. Treatment, therefore, may be necessary for several years, sometimes for as long as the disease remains active or to prevent relapse.
In addition to corticosteroids, various other drugs have been tried, but their effectiveness has not been established in controlled studies. These drugs include chloroquine (Aralen) and D-penicillamine. Several drugs such as chlorambucil (Leukeran), azathioprine (Imuran), methotrexate (Rheumatrex, Trexall), and cyclophosphamide (Cytoxan), which might suppress alveolitis (inflammation of the air sacs of the lungs) by killing the cells that produce granulomas, have also been used. None have been adequately evaluated in controlled clinical trials, and the risk of using these drugs must be compared closely with the benefits in preventing organ damage by the disease. They should not be used by pregnant women.
Cyclosporine, a drug used widely in organ transplants to suppress immune reaction, has been evaluated in one controlled trial and was found to be unsuccessful in the treatment of sarcoidosis in this study. More recently, thalidomide (Thalomid) has been used successfully in a limited number of patients and seemed to improve lung function and heal skin lesions. Infliximab (Remicade) has been reported recently as effective in treating patients with sarcoidosis.
For difficult to treat (refractory) sarcoidosis and sarcoidosis involving the nervous system (neurosarcoidosis), recent research using biologic medications that inhibit tumor necrosis factor (TNF-blockers) has been found in some studies to be beneficial. The TNF-blockers used were adalimumab (Humira) and infliximab (Remicade).
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