Immunosuppressive therapies for sarcoidosis
| Drug | Usual dosage | Major toxicities | Recommended monitoring | Comments |
| Prednisone/prednisolone | Initial 20 mg once a day; follow-up 5–10 mg once a day to once every other day | Diabetes; hypertension; weight gain; osteoporosis; cataracts; glaucoma; moodiness | Bone density; blood pressure and serum glucose | Cumulative toxicity |
| Methotrexate | 10–15 mg once a week | Nausea; leukopenia; hepatotoxicity; pulmonary | CBC, hepatic, renal serum testing | Cleared by kidney, avoid in significant renal failure |
| Leflunomide | 10–20 mg once a day | Nausea; leukopenia; hepatotoxicity; pulmonary | CBC, hepatic, renal serum testing | Cleared by kidney, avoid in significant renal failure |
| Azathioprine | 50–250 mg once a day | Nausea; leukopenia; infections; malignancy | CBC | |
| Mycophenolate mofetil | 500–1500 mg twice a day | Diarrhoea; leukopenia; infections; malignancy | CBC | Less experience in sarcoidosis than other agents |
| Infliximab or biosimilars# | 3–5 mg·kg−1 initially, 2 weeks later, then once every 4–6 weeks | Infections; allergic reaction | Screen for prior TB; monitor for allergic reactions; contraindicated in severe CHF, prior malignancy, demyelinating neurologic disease, active TB, deep fungal infections | Allergic reactions can be life threatening |
| Adalimumab# | 40 mg every 1–2 weeks | Infections | Screen for prior TB; monitor for allergic reactions; contraindicated in severe CHF, prior malignancy, demyelinating neurologic disease, active TB, deep fungal infections | Less toxic than infliximab |
| Rituximab# | 500–1000 mg every 1–6 months | Infections | Screen for viral hepatitis; check IgG level with chronic therapy | High risk for viral reactivation; can lead to IgG deficiency |
| RCI# | 40–80 units twice a week | Diabetes; hypertension; oedema; anxiety | Monitor glucose and blood pressure | Most of toxicity is on day of injection |
| Hydroxychloroquine | 200–400 mg once a day | Loss of vision | Ocular exams periodically depending on age and renal function | Minimal impact on cardiac and neurologic disease |
More details regarding dosages, major toxicities and monitoring are given in supplement S1 in the supplementary material and adapted from prior reports [4, 39–48]. CBC: complete blood count; TB: tuberculosis; CHF: congestive heart failure; RCI: repository corticotropin injection. #: use reserved for patients who have failed prior treatments with steroids and/or antimetabolites.