In patients with sarcoidosis and persistently elevated liver function tests, when do you consider initiating ursodeoxycholic acid (UDCA)?

In patients with systemic sarcoidosis with predominantly elevated alkaline phosphatase, I would be suspicious for liver involvement of their sarcoidosis. If treatment of the systemic sarcoidosis with immunosuppression (typically initiated by Pulmonology or Rheumatology) are ineffective for improving...

If the alk phos is high and there is a cholestatic pattern, then I often empirically treat because the risk of ursodiol is low at the general doses we use for hepatic sarcoidosis (13-15 mg/kg PO daily). The adverse effects are minimal at this dose compared to the high dose used in PSC (28-30 mg/kg P...