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Tuesday, March 11, 2014
Other Treatments For Sarcoidosis
My son has been diagnosed with Sarcoidosis and a corticosteroid is being prescribed. Having reviewed the potential side effects, I wonder if some less dangerous drug can be used to treat this disease.
Would the tumor necrosis factor drugs be less potentially dangerous?
Decisions related to treatment of sarcoidosis are complicated, and should be considered on an individual basis. Corticosteroids are commonly used to control serious disease complications, especially during the initial phase of the disease.
This is because corticosteroids act relatively quickly and are effective in most cases. However, the dose of corticosteroids should be adjusted within the first four to six weeks of therapy to find the lowest effective dose.
If long-term treatment is necessary or if the dose of corticosteroids cannot be reduced to a relatively low dose, for example no more than 20 milligrams of prednisone every other day, then the doctors should consider adding a "second line" or "steroid sparing" agent.
There are a number of steroid sparing drugs, but the experience with methotrexate is the greatest. The ultimate goal is to use the lowest effective dose of medications to control life-altering effects of the disease.
If treatment is too aggressive, the side effects of the treatments can be worse than the disease itself. This risk-benefit analysis has to be considered throughout the duration of treatment, which can be life-long in some cases.
The anti-TNF drugs are generally reserved for sarcoidosis cases that fail to respond to a combination of corticosteroids and one or more second line drugs (such as methotrexate).
These drugs are extremely expensive and have potentially serious side effects, including severe infections. In some cases, the anti-TNF drugs have to be used in combination with one or more of the "conventional" therapies.
As you can see, it is advantageous to seek the advice of a physician experienced in the care of sarcoidosis patients.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University