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

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.