Current recommendations favour prednisone as first-line treatment for symptomatic pulmonary sarcoidosis, followed by methotrexate as a second-line option. Kahlmann and colleagues investigated the relative efficacy and safety of methotrexate compared to prednisone for first-line treatment in their open-label, noninferiority study. Methotrexate was non-inferior to prednisone in terms of the primary end point. Incidence of side-effects was similar, meaning that methotrexate is a viable option for patients unable or unwilling to use corticosteroids.

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