BACKGROUND: Prednisone is used as first-line therapy for pulmonary sarcoidosis. 
What dosing strategy has the best balance between effect and side-effects is 
largely unknown. We analyzed change in forced vital capacity (FVC) and weight 
during different prednisone doses used in daily practice for treatment naïve 
pulmonary sarcoidosis patients.
METHODS: Multilevel models were used to describe FVC and weight change over 
time. Correlations were calculated using linear regression models.
RESULTS: Fifty-four patients were included. FVC changed over time (p < 0.001), 
with an average increase of 9.6% predicted (95% CI: 7.2 to 12.1) at 12 months. 
Weight changed significantly over time (p < 0.001), with an average increase of 
4.3 kg (95% CI: 3.0 to 5.6) at 12 months. Although FVC and weight changed 
significantly over time, there was little correlation between prednisone dose 
and FVC change, while weight increase correlated significantly with cumulative 
prednisone dose at 24 months. In patients treated with a high cumulative 
prednisone dose, baseline FVC was on average lower (p = 0.001) compared to low 
dose treated patients, while no significant differences were observed in need 
for second/third-line therapy or number of exacerbations. A strategy leading to 
a low cumulative dose at 12 months was defined by rapid dose tapering to 
10 mg/day within 3.5 months.
CONCLUSIONS: These results suggest that prednisone therapy aimed at improving or 
preserving FVC in newly- treated pulmonary sarcoidosis can often be reduced in 
dose, using a treatment regimen that is characterized by early dose tapering.