Glucocorticoid Use Common But Insufficient for Pulmonary Sarcoidosis, Study Finds

New research is shedding light on real-world treatment patterns for pulmonary sarcoidosis with parenchymal involvement in the United States, highlighting high rates of glucocorticoid use and the frequent need for later-line therapies.1

The data were presented at the American Thoracic Society (ATS) International Conference 2025 by Eileen Sun, PhD, MBA, executive director of product development at aTyr Pharma, and call attention to a substantial unmet need for new treatments for pulmonary sarcoidosis that provide effective sustained responses with less toxicity.1

An inflammatory disease in which the immune system overreacts, causing groups of cells to form clusters of inflamed tissue called "granulomas" in one or more organs of the body, sarcoidosis most commonly affects the lungs and lymph nodes. According to the American Lung Association, sarcoidosis is a rare disease with 150,000-200,000 cases in the United States per year and approximately 27,000 new cases per year.2

The main goals of treatment are to manage symptoms, decrease the risk of organ damage, and improve quality of life. Frequently, this entails use of corticosteroids to reduce immune system activity and lessen inflammation.2

“Pulmonary sarcoidosis treatment guidelines recommend glucocorticoids and later-line immunomodulators, but acknowledge limited supporting evidence,” Sun and colleagues wrote.1 “No new therapies have been FDA approved for sarcoidosis in almost 70 years. Glucocorticoid toxicity creates a substantial burden for patients and warrants careful consideration of treatment selection.”

Investigators examined data from the 2017-2023 Marketscan Commercial Claims and Encounters database for patients with sarcoidosis with diagnosed parenchymal lung involvement from July 2019-June 2020 using ICD-10 diagnosis codes. Patients without D86.0 or D86.2 codes in 2 years pre-index were considered incident.1

Investigators assessed glucocorticoid, immunosuppressant, biologic, repository corticotrophin injection, JAK inhibitor, and anti-fibrotic treatment use in medical and pharmacy claims. Rates and type of treatment were assessed over 3 years post-index, and in the case of combination regimens, drug types were considered separately.1

Of 1166 pulmonary sarcoidosis patients with parenchymal involvement, 136 were deemed incident and 1030 non-incident. Among incident patients, 54% required treatment within 1 year. Of the treated incident patients, 92% used glucocorticoids, 23% required immunosuppressants, and 5% required biologics. By 3 years, 72% required treatment, of which 97% used glucocorticoids, 28% immunosuppressants, and 7% biologics.1

Investigators noted rates of overall treatment and use of later-line therapies were greater among non-incident patients, with 65% receiving treatment within 1 year of index. Among treated non-incident patients, 86% used glucocorticoids, 40% immunosuppressants, and 11% biologics in the index year. In the 3-year window, 78% of non-incident patients were treated. Of these, 94% used glucocorticoids, 42% immunosuppressants, and 12% biologics.1

“Patients with pulmonary sarcoidosis have substantial unmet need for new, indicated treatments that provide effective sustained responses with less toxicity,” investigators concluded.1

References

1. Sun E, Mosher K, Yan Y, et al. Real-World Treatment Patterns Among Pulmonary Sarcoidosis Patients With Parenchymal Involvement in the US [abstract]. Am J Respir Crit Care Med 2025;211:A1830. https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A1830

2. American Lung Association. Sarcoidosis. Accessed May 19, 2025. https://www.lung.org/lung-health-diseases/lung-disease-lookup/sarcoidosis