Corticosteroids remain first-line for symptomatic pulmonary sarcoidosis, with steroid-sparing agents (methotrexate, azathioprine) and anti-TNF therapy (infliximab) for refractory disease — and the search for better-tolerated, steroid-sparing options continues. The most watched candidate has been efzofitimod, a novel immunomodulator that selectively binds neuropilin-2. Its Phase 2 trial suggested meaningful steroid reduction and was well tolerated, generating real optimism. However, the confirmatory Phase 3 EFZO-FIT trial did not meet its primary endpoint (2025), which has left the drug's future uncertain and tempers the earlier enthusiasm. For the fibrotic sarcoidosis phenotype, antifibrotics such as nintedanib may slow progression (extrapolating from progressive fibrosing interstitial lung disease data), though dedicated randomized trials are still needed.
Further reading: efzofitimod Phase 2 (Culver et al., Chest 2023) and Phase 3 EFZO-FIT (2025); antifibrotics in fibrotic sarcoidosis (Bączek & Piotrowski, 2024).