Introduction: Pharmacologic therapy for sarcoidosis is largely clinician-driven and is associated with substantial cumulative morbidity. Whether racial differences in treatment intensity persist after adjustment for disease severity is uncertain, and community-practice data are scarce.

Objectives: To describe pharmacologic treatment patterns by self-reported race and to determine whether racial differences in treatment intensity persist after adjustment for age, sex, BMI, and radiographic severity.

Materials and Methods: Retrospective five-site Central Florida community pulmonary practice cohort, January 2016–January 2026. Adults with physician-confirmed sarcoidosis and at least one available outcome (modified Scadding stage on chest CT, GLI 2012 spirometry pattern, or DLCO interpretation) were stratified by self-reported race (White, Black/African American, Hispanic, Other/Unknown). Pharmacologic therapy was defined as the use of each agent and was grouped into corticosteroids, conventional immunosuppressants, biologic/targeted therapy, and antifibrotics. Multivariable logistic regression for any therapy, corticosteroid use, and biological use was adjusted for age, sex, BMI, and modified Scadding stage.

Results: In total, 505 patients (213 White, 115 Black, 125 Hispanic, 52 Other/Unknown; 63% female; mean age 62 ± 14 years) were included. Overall, 58% of patients required pharmacologic therapy; prednisone (53%), methotrexate (24%), and hydroxychloroquine (17%) were the most commonly used agents. On bivariate testing, the proportion of patients who required any therapy did not differ significantly across races (55–65%; p = 0.34); however, after adjustment for age, sex, BMI, and stage at which patients were diagnosed, being black was independently associated with 2.4-fold greater odds of receiving any therapy than being white (adjusted OR 2.39, 95% CI 1.22–4.66; p = 0.011) and 1.9-fold greater odds of corticosteroid use (adjusted OR 1.90, 95% CI 1.05–3.46; p = 0.035). Adjusted odds did not differ significantly for Hispanic or Other/Unknown groups. Biologic and targeted therapy use was uncommon (4.8% overall) and did not differ across races.

Conclusions: In a 10-year community pulmonary cohort, compared with White patients, Black patients had substantially higher adjusted odds of receiving systemic therapy and corticosteroids, independent of age, sex, BMI, and radiographic severity. These disparities persist in everyday practice and may reflect residual unmeasured severity, clinician decision-making, or both.