There is no generally accepted definition of refractory sarcoidosis. Considering the opinion of world leading experts and our own experience we can offer the following definition - the variant of sarcoidosis, when systemic glucocorticosteroids (GCS) in maintenance dose of  ? 10 mg daily (prednisolone equivalent) and methotrexate (MTX) alone or in combination are not effective enough to achieve clinical remission.

Aim: to evaluate retrospectively the prevalence of refractory pulmonary sarcoidosis.

Methods. We examined 250 patients with sarcoidosis ? 106 men (42,4 %), and 144 women (57,6 %), mean age 44 years, radiological stage II ? 237 (94,8 %), stage 3 ? 13 (5,2 %).GCS therapy using methylprednisolone (MP) was initiated in 190 patients with starting dose of 0,4 mg/kg for 4 weeks, following the tapering of the dose down to 0,1 mg/kg by the end of 6th month. MTX as monotherapy (15 mg once per week) was administered to 60 patients with contraindications to GCS or serious adverse reactions on MP. In case of progression of the disease or lack of response, a combination therapy was used: MP 12 mg daily and MTX 10 mg once a week. In patients with progression or stabilization of the disease after being on this therapy for at least 6 months, we considered as refractory sarcoidosis. 

Results. Resistance to GCS therapy (progression or stabilization on the background of treatment) was registered in 55 (28,9 %) patients. Treatment failure among patients taking MTX was observed  less often (7 patients ? 11,7 %). Refractory pulmonary sarcoidosis was observed in 27 (10,8 %) of patients.

Conclusion. Prevalence of refractory pulmonary sarcoidosis in Ukraine is 10,8 %.