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As noted above, the ERS guidelines reaffirmed two major reasons to initiate treatment ( Although the guidelines and a previously published consensus study advocate for early introduction of steroid-sparing agents, there is no definition of how early these can be added ( Corticosteroids have historically been the prototypical treatment in sarcoidosis, yet they are associated with a reduced HRQoL and significantly high morbidity and organ-threatening toxicities that are dependent on dose, duration and in some cases, genetic make-up ( Approaches to systemic treatment The ERS guidelines and a recently published Delphi consensus statement from a large group of worldwide sarcoidosis experts advocate an approach to therapy that balances the use of reduced doses of corticosteroids with the (early) stepwise addition of steroid sparing anti-inflammatory non-biologic and biologic agents ( The proposed approach to corticosteroid use is to limit continuation to a 36 month period to allow for demonstration of therapeutic response ( For patients with symptomatic pulmonary sarcoidosis believed to be at higher risk of future mortality or permanent disability from sarcoidosis who have been treated with glucocorticoids or other IST and have continued disease, the guidelines suggest the addition of infliximab to improve and/or preserve lung function and HRQoL (Table 1 and the stepwise approach to treatment in pulmonary sarcoidosis is shown in Figure 1

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