What is your approach to tapering therapy in patients with pulmonary sarcoidosis who are asymptomatic with stable pulmonary function and imaging?

We generally do not use weight-based dosing for treating sarcoidosis but often will use 20 mg daily (0.25 mg/kg) as a starting point. If a patient is newly started on prednisone, then we may use a gradual taper 20 mg daily for 1 month, then 15 mg daily for 1 month, then 10 mg daily until they are reassessed in another 1-2 months. If a patient has very extensive infiltrates and it is critical to ensure a response to treatment, we may maintain a higher dose (15 mg or 20 mg) through the first 3-4 months. We may start a steroid-sparing agent such as methotrexate earlier (or even concurrently with starting prednisone) in patients with very extensive burden of sarcoidosis in the lung, have moderate to severe pulmonary function abnormalities, have...