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Patients with sarcoidosis undergo spontaneous remission or may be effectively controlled with glucocorticoids alone in many cases. Progressive and refractory pulmonary sarcoidoisis constitute> 10% of the patients seen at specialized centers. Pulmonary fibrosis and associated complications, such as infections and pulmonary hypertension, are leading causes of mortality. No universal definition of refractoriness exists; we therefore propose classifying patients as having refractory disease when the following criteria are fulfilled:(1) progressive disease despite at least 10 mg of prednisolone or equivalent for at least 3 months and the need for additional disease-modifying antisarcoid drugs due to a lack of efficacy, drug toxicity, or intolerability; and (2) treatment started for significant impairment of life due to progressive pulmonary symptoms. Both criteria should be fulfilled. Treatment options in addition to or instead of …