Treatment principles
Medical management with oral corticosteroids is the mainstay of
treatment in generalised sarcoidosis and in severe otolaryngologic
disease (1, 9, 17). However, the risks of uncontrolled disease need to
be balanced against the incumbent risks and side-effects of long-term
corticosteroid therapy (10). Adjunctive or alternate drug therapies have
therefore also been used in order to reduce steroid doses (18, 19).
These include:
- Cytotoxic agents (such as methotrexate, azathioprine, cyclophosphamide
and chlorambucil)
- Anti-malarial drugs (chloroquine and hydroxychloroquine)
- TNF-alpha inhibitors (infliximab, adalimumab, etanercept).
No control studies exist as yet comparing these therapies to steroid
treatment, but effective treatment is reported anecdotally in cases of
sarcoidosis with extrathoracic manifestations such as lupus pernio and
uveitis (18, 19). Furthermore, specific treatments can be helpful in the
local management of otorhinolaryngologic sarcoidosis, and these are
discussed below.