Journal article
A paradigm shift in corticosteroid therapy for sarcoidosis: a World Association of Sarcoidosis and Other Granulomatous Disorders Position Paper, endorsed by the Americas Association of Sarcoidosis and Other Granulomatous Disorders
The lancet respiratory medicine, Vol.14(4)
03/31/2026
DOI: 10.1016/S2213-2600(25)00338-8
PMID: 41207318
Abstract
For over seven decades, oral corticosteroids have been the cornerstone of sarcoidosis management. Oral corticosteroids suppress sarcoidosis inflammation rapidly, but long-term oral corticosteroids result in toxicity and some patients are unable to taper oral corticosteroids without experiencing disease flare ups. The routine use of oral corticosteroids as first-line therapy, as recommended in sarcoidosis guidelines, could have unintentionally promoted the long-term use of oral corticosteroids. We believe that oral corticosteroids should no longer be considered as first-line therapy in all patients with sarcoidosis requiring treatment. Furthermore, we view long-term use of oral corticosteroids in sarcoidosis as an undesirable outcome. When initial oral corticosteroids are required, we propose that oral corticosteroids be used as bridging therapy, ideally for no longer than 3–4 months. There is an urgent need to address the widespread use of long-term maintenance therapy with oral corticosteroids in patients with sarcoidosis, and we advocate the systematic withdrawal of steroid therapy with replacement, if necessary, by other immunosuppressive agents.
Details
- Title: Subtitle
- A paradigm shift in corticosteroid therapy for sarcoidosis: a World Association of Sarcoidosis and Other Granulomatous Disorders Position Paper, endorsed by the Americas Association of Sarcoidosis and Other Granulomatous Disorders
- Creators
- Athol U Wells - Royal Brompton HospitalElyse E Lower - University of CincinnatiRobert P Baughman - University of CincinnatiDaniel A Culver - Cleveland ClinicMarc A Judson - Albany Medical Center HospitalCatherine A Bonham - University of VirginiaAlicia K Gerke - University of IowaJan C Grutters - St. Antonius ZiekenhuisChris Knoet - British Lung FoundationFilippo Martone - British Lung FoundationKatja Schillhorn - British Lung FoundationJohn H Stone - Harvard UniversityAndrea B Wilson - Foundation of Sarcoidosis Research, Chicago, IL, USAElliott D Crouser - The Ohio State University Wexner Medical Center
- Resource Type
- Journal article
- Publication Details
- The lancet respiratory medicine, Vol.14(4)
- DOI
- 10.1016/S2213-2600(25)00338-8
- PMID
- 41207318
- NLM abbreviation
- Lancet Respir Med
- ISSN
- 2213-2600
- eISSN
- 2213-2619
- Publisher
- Elsevier Ltd
- Grant note
- Amgen: Q32 Sanofi National Institute of Health, Milken Institute, Ann Theodore Sarcoidosis: 23 Boehringer Ingelheim Merck World Association of Sarcoidosis and Other Granulomatous Disorders National Institute of Health Ann Theodore Foundation
Palleon, Prometheus Biosciences/Merck, Polaris, Platformhq, Q32, Quotient, Salvina Therapeutics, Sanofi, Tourmaline Bio, and ZenasBio; grants from Amgen, Sanofi, Zenas Bio, and Acepodia; support for travel from Amgen; safety advisory board roles for Amgen, Agdenx, Horizon, IQVIA, and Sanofi; stock options for Zenas Bio; and is the Executive Chairman of the IgG4ward! Foundation. ABW declares consultancy fees from aTyr. EDC declares grants from the National Institute of Health, Milken Institute, Ann Theodore Sarcoidosis, 23&ME, Xentria, Electra, and aTyr; consultancy fees from Sarcomed, Boehringer Ingelheim, and Merck; and support for travel from the Irish and Italian Thoracic Societies. EEL declares support from The World Association of Sarcoidosis and Other Granulomatous Disorders to attend a World Association of Sarcoidosis and Other Granulomatous Disorders Task Force meeting. CAB declares grants from the National Institute of Health; advisory board membership for the Ann Theodore Foundation; and support from The World Association of Sarcoidosis and Other Granulomatous Disorders to attend a World Association of Sarcoidosis and Other Granulomatous Disorders Task Force meeting. FM declares advisory board membership for the Ann Theodore Foundation. AKG, JCG, CK, and KS declare no competing interests.
- Language
- English
- Electronic publication date
- 11/06/2025
- Date published
- 03/31/2026
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9985027461902771
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