ABSTRACT
Corticosteroids (CSs) are the cornerstone of therapy for severe or progres-
sive sarcoidosis (pulmonary or extrapulmonary) and often produce dramatic resolution of disease (1-3). The long-term benefit of corticosteroid (CS) therapy is less clear, as relapses may occur upon taper or cessation
of therapy (1,4). As will be discussed in detail in this chapter, only a few ran-
domized trials evaluated CSs for pulmonary sarcoidosis, and results were
inconclusive. It should be emphasized that prospective studies in patients
with deteriorating pulmonary function have not been done, because there is general agreement that such patients require treatment. Because spontaneous remissions (SRs) occur commonly in sarcoidosis, the impact of treatment is difficult to ascertain. Further, even when short-term responses
appear evident, long-term benefit is controversial. Interpretation of both
retrospective and prospective studies is clouded by different indications
for treatment, heterogeneous patient populations, differing dosages and
duration of therapy, lack of reliable parameters of disease activity, and
the lack of standardized or objective criteria for response. Notwithstanding
these difficulties, extensive clinical experience suggests that CSs are benefi-
cial and potentially life saving in patients with active, symptomatic disease involving lungs or extrapulmonary organs (3,5-7).
