Table 2 Inclusion and exclusion criteria

- Diagnosis of sarcoidosis according to the ATS/ERS/WASOG criteria [6], in case of absent histology a diagnosis of sarcoidosis can also be established in a multidisciplinary team meeting in a sarcoidosis expert center based on a highly suggestive clinical and radiological picture [22]

- Age ≥ 18 years

- A pulmonary indication for treatment and parenchymal involvement on X-ray or chest CT-scan conducted within three months before inclusion (determined by the treating physician and according to current guidelines)

- A forced vital capacity (FVC) of ≤90% of predicted, or a diffusion capacity of the lung for carbon monoxide (DLCO) ≤70% of predicted, or an absolute decline of ≥5% FVC decline, or an absolute ≥10% DLCO decline in the past year

- Any condition or circumstance that, in the opinion of the investigator, may make a subject unlikely or unable to complete the study or comply with study procedures

- Previous immunosuppressive treatment for sarcoidosis

- Use of systemic immunosuppressive therapy within the preceding three months for another disease than sarcoidosis

- Pregnant, breastfeeding, or planning to become pregnant or breastfeed during the study treatment or within 90 days after the last dose in the randomized study phase. For males; planning to pro-create during the study or within 90 days after the last dose of the randomized study phase

- Primary systemic treatment indication being an extra pulmonary location of sarcoidosis (e.g. cardiac of neurological)

- Contra-indication for methotrexate or corticosteroids^a