Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis

Eur Respir Rev. 2020 Mar 20;29(155):190146. doi: 10.1183/16000617.0146-2019. Print 2020 Mar 31.


Pulmonary sarcoidosis presents substantial management challenges, with limited evidence on effective therapies and phenotypes. In the absence of definitive evidence, expert consensus can supply clinically useful guidance in medicine. An international panel of 26 experts participated in a Delphi process to identify consensus on pharmacological management in sarcoidosis with the development of preliminary recommendations.The modified Delphi process used three rounds. The first round focused on qualitative data collection with open-ended questions to ensure comprehensive inclusion of expert concepts. Rounds 2 and 3 applied quantitative assessments using an 11-point Likert scale to identify consensus.Key consensus points included glucocorticoids as initial therapy for most patients, with non-biologics (immunomodulators), usually methotrexate, considered in severe or extrapulmonary disease requiring prolonged treatment, or as a steroid-sparing intervention in cases with high risk of steroid toxicity. Biologic therapies might be considered as additive therapy if non-biologics are insufficiently effective or are not tolerated with initial biologic therapy, usually with a tumour necrosis factor-α inhibitor, typically infliximab.The Delphi methodology provided a platform to gain potentially valuable insight and interim guidance while awaiting evidenced-based contributions.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use*
  • Algorithms*
  • Biological Products / adverse effects
  • Biological Products / therapeutic use*
  • Clinical Decision-Making*
  • Consensus
  • Decision Support Techniques*
  • Delphi Technique
  • Humans
  • Immunologic Factors / adverse effects
  • Immunologic Factors / therapeutic use*
  • Lung / drug effects*
  • Lung / physiopathology
  • Sarcoidosis, Pulmonary / diagnosis
  • Sarcoidosis, Pulmonary / drug therapy*
  • Sarcoidosis, Pulmonary / physiopathology
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Biological Products
  • Immunologic Factors