A Cochrane review [Abstract] 1 included 13 studies of variable quality with a total of 1 066 subjects. The oral steroid dose was equivalent to prednisolone 4-40 mg/day. With oral steroids, there was an improvement in chest x-ray over 3-24 months (relative risk [RR] 1.46, 95% confidence interval [CI] 1.01 to 2.09; 3 studies), but this finding requires cautious interpretation. No other significant differences were identified on secondary outcomes. With inhaled steroids, data were inadequate to perform meaningful analysis. Two studies showed no improvement in lung function. In one study there was an improvement in diffusing capacity in the treated group. There were no data on side-effects. In one study symptoms improved at the end of six months of treatment.
In a randomized controlled trial 2, 149 patients with stage I (n=79) and stage II (n=70) newly detected pulmonary sarcoidosis, who were initially treated with oral prednisolone for 3 months followed by inhaled budesonide for 15 months (800 µg bid), or with placebo, were followed up for 5 years. No initial differences were observed in chest radiographic findings between the active treatment and placebo groups. However, after the 5-year follow-up, 18 steroid-treated patients (26%) and 30 placebo-treated patients (38%) still had remaining chest radiographic changes. Placebo-treated patients more frequently required treatment with corticosteroids during the 5-year follow-up (p < 0.05). Steroid-treated patients with initial stage II(-III) disease improved more in FVC and diffusion capacity of the lung for carbon monoxide (DLCO; p < 0.05). The authors conclude that immediate treatment of pulmonary stage II(-III) sarcoidosis - but not stage I disease - improved the 5-year prognosis with regard to lung function variables.
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