Most sarcoidosis patients experience disease remission within the first 3 years of diagnosis with no long-term complications but one-third of patients have persistent disease, which causes organ failure. The treatment requires consideration of sarcoidosis-related complications and treatment side effects.

Most sarcoidosis patients experience disease remission within the first 3 years of diagnosis with no long-term complications but one-third of patients have persistent disease, which causes organ failure. The treatment requires consideration of sarcoidosis-related complications and treatment side effects.^[1][2]

Not all patients require therapy at first^[3][4][5]. The decision to treat the patients is based on symptoms and organ function impairment^[4]

• Corticosteroids are the most commonly used and most effective medications for sarcoidosis^[6][7][8]. Patients who do not respond to prednison 40 mg daily, are named refractory to standard treatment and can be considered for alternative treatments. Significant percentage of patients will require long-term treatment with corticosteroids, thus corticosteroid-sparing agents are being considered in this patients to avoid the cumulative side effects of the corticosteroids^[9]

• Antimalarial agents are effective in cutaneous, sinonasal disease and hypercalcemia^[10][11][12]

• Methotrexate has been shown to be effective in ocular, cutaneous, sinus, and neurologic disease^{[13][14][15][16][17][18]}

• Azathioprine can be effective in pulmonary and extra-pulmonary disease^[19]

• Mycophenolate analogues are effective against inflammatory lung disease^[20][21]

• Infliximab is effective against refractory cases of pulmonary, lupus pernio, eye, and neurologic disease^[22][23][24]

• Adalimumab is effective in some sarcoid cases^[25][26]