Acthar Gel is a repository corticotropin injection approved for the treatment of several conditions, including pulmonary sarcoidosis. Acthar Gel is administered as an injection under the skin (subcutaneously) or into the muscle tissue (intramuscularly). It is an alternative treatment for patients who do not tolerate or respond to the corticosteroid prednisone, which is the first-line treatment for sarcoidosis.
Anti-malarials work by suppressing the immune response by preventing the release of chemicals that normally promote inflammation. They also stop the activation of immune cells called T-cells, which play an important role in the formation of granulomas. Anti-malaria treatments may be used to treat several types of sarcoidosis, including cutaneous sarcoidosis, pulmonary sarcoidosis, and neurosarcoidosis, as well as arthritis.
Cyclophosphamide is a chemotherapy approved to treat a number of cancers, and may be used to treat select sarcoidosis patients because of its ability to suppress the immune system. Specifically, cyclophosphamide is generally reserved for people with severe disease, such as neurosarcoidosis and cardiac sarcoidosis, that cannot be controlled by medications such as methotrexate or azathioprine.
Cyclosporine, also called cyclosporine A, is a medication that suppresses the immune system. It is used treat symptoms of psoriasis and inflammatory eye conditions, and has been reported to be effective in treating those of ocular sarcoidosis. It is often used as a steroid-sparing agent in patients who do not tolerate or respond to corticosteroids, such as prednisone.
Durezol (difluprednate) is an approved medication for the treatment of inflammation and pain associated with ocular surgery. A corticosteroid, it is also used to treat uveitis (inflammation of the middle layer of the eye) in patients with ocular sarcoidosis.
Humira (adalimumab), is a tumor necrosis factor alpha (TNF-alpha) inhibitor approved for the treatment of rheumatoid arthritis and several other autoimmune diseases. The active ingredient in Humira, adalimumab, also is effective in easing sarcoidosis symptoms. It is injected under the skin or into the vein and can be used in patients who cannot be treated with standard sarcoidosis therapies.
Imuran (azathioprine) is a cytotoxic (cell-killing) compound approved and used to treat sarcoidosis in patients who are resistant to or cannot tolerate steroid treatments. Generic formulations of this treatment are available, and it is an alternative to methotrexate, which some patients cannot take because of liver or kidney damage.
Leukeran (chlorambucil) is a chemotherapy used to treat certain forms of leukemia. It is used selectively to treat sarcoidosis patients who do not respond to corticosteroids. Leukeran is a cytotoxic agent that works to reduce cell growth. This results in slower immune cell growth, which may reduce the formation of granulomas in sarcoidosis patients.
Methotrexate is a cytotoxic agent approved to treat various cancers, adults with severe psoriasis and severe rheumatoid arthritis. In sarcoidosis, methotrexate can slow the growth of immune cells to lower immune system sensitivity and reactivity. It is used as an alternative to corticosteroids such as prednisone, especially in patients who fail to respond well to them.
Non-steroidal anti-inflammatory drugs, or NSAIDs, can be used in sarcoidosis patients to reduce inflammation and pain. They are usually are prescribed as a first-line therapy for musculoskeletal sarcoidosis, in particular for Löfgren syndrome or arthritis-like symptoms, such as stiff, swollen, or painful joints.
Pentoxifylline is a treatment approved to improve blood flow that also can be used to treat sarcoidosis. In addition to improving blood flow, pentoxifylline inhibits the synthesis of TNF-alpha. In sarcoidosis, the immune system can be overactivated. By decreasing TNF-alpha signaling, pentoxifylline reduces the immune response.
Prednisone is a corticosteroid approved to treat many different conditions and has proven effective in treating the symptoms of sarcoidosis. It works by mimicking the effect of cortisol, a naturally-occurring steroid hormone in the body, making the immune system less sensitive to what it perceives as threats.
Remicade (infliximab) is a monoclonal antibody therapy approved to treat several inflammatory diseases, including rheumatoid arthritis and Crohn’s disease. The treatment also can be used for sarcoidosis when patients do not respond to other medications. Remicade blocks the action of the TNF-alpha protein that is involved in the inflammatory response, reducing inflammation and damage.
Rituximab, a medication that targets immune system cells called B-cells, can be used to treat sarcoidosis. It is an anti-CD20 monoclonal antibody that specifically binds to a molecular marker known as CD-20, which is mostly found on the surface of B-cells. By targeting CD-20, rituximab can reduce excess B-cell production and lower inflammation.
Thalomid (thalidomide) may be used to treat the symptoms of sarcoidosis. It works by inhibiting TNF-alpha. In sarcoidosis, the immune system can be activated too strongly, or activated by the wrong things. By suppressing TNF-alpha, Thalomid may reduce the immune response.
Xeljanz (tofacitinib) is an oral treatment approved to treat rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. It has also been used off-label to treat cutaneous sarcoidosis. Xeljanz works by blocking the function of an enzyme called Janus kinase, preventing immune cells from becoming pro-inflammatory.