Context Corticosteroids are used in pulmonary sarcoidosis to reduce symptoms
and minimize long-term damage. Spontaneous recovery is a common feature. Both
the decision to initiate therapy and the treatment response may be influenced
by disease severity, so trials need to use a randomized controlled design.
Objective To assess the effect of oral and inhaled corticosteroids on chest radiograph
results, symptoms, pulmonary function, and long-term outcome in pulmonary
Data Sources MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register
were searched all years through December 2001. Bibliographies of review articles
and retrieved articles were searched, and pharmaceutical companies and authors
of identified trials were contacted for other studies. There was no language
Study Selection Trials were randomized and included a control group. Participants were
adults with histologic evidence of pulmonary sarcoidosis. Treatments included
the use of oral and inhaled corticosteroids for at least 8 weeks. The search
identified 150 studies; 9 met the inclusion criteria, but only 8 provided
Data Extraction Two reviewers assessed trial quality using the Jadad score, which evaluates
the quality of randomization, blinding, and reasons for withdrawal. Data were
extracted and sent to primary authors for verification.
Data Synthesis In patients with stage 2 and 3 disease, oral corticosteroids improved
findings on the chest radiograph after 6 to 24 months (Peto odds ratio, 2.54;
95% confidence interval [CI], 1.69-3.81; P<.001).
Forced vital capacity improved with oral corticosteroids (weighted mean difference
[WMD], 4.2% predicted; 95% CI, 0.4%-7.9% predicted) and diffusing capacity
also improved (WMD, 5.7% predicted; 95% CI, 1.0%-10.5% predicted). In 2 small
studies of inhaled corticosteroids, there was no effect on chest radiograph
and inconsistent effects on lung function in one and only a small improvement
in symptoms in the other. There were no data following corticosteroid withdrawal
to assess any disease-modifying effect.
Conclusions Oral corticosteroids improved results on the chest radiograph following
6 to 24 months of treatment and produced a small improvement in vital capacity
and diffusing capacity. Trials of inhaled corticosteroids were small and results
too inconsistent to make firm conclusions concerning their efficacy. There
are no data to suggest that corticosteroid therapy alters long-term disease