Course of sarcoidosis in patients treated with systemic corticosteroids

Abstract

The treatment of sarcoidosis remains uncertain despite 70 years of studies. The conventional approach is to initiate corticosteroids in individuals who require treatment. However, to date, there are no strict dosing regimens for systemic corticosteroids (SСS), and patients who were treated with SСS develop relapses more frequently than those who have not received these drugs. The aim of this work was to evaluate the course and outcomes of pulmonary sarcoidosis in patients who were prescribed systemic corticosteroids. Methods. The study was retrospective and noninterventional. 493 (32.5%) of 1,518 patients with sarcoidosis were prescribed corticosteroids during follow-up. Only 333 cases were selected because they had histologic confirmation and follow-up of 1 year or more. The data at the time of diagnosis and at the time of analysis were compared (patients remained under the supervision of the same physicians thereafter). Results. After at least one year of follow-up, the positive effect of SCS (resolution or stabilization of the process) was achieved only in half of the cases, while the rest of the patients required more courses of SCS or the use of alternative drugs. Worsening was more common when multiple organs were involved, when SCS were administered immediately after diagnosis without a follow-up period, and when the duration of the first course of hormone therapy was less than 7 months. 33.6% of patients treated with SCS had clinically significant adverse events (AEs), and 13.2% had to discontinue or replace one hormonal drug with another. Older age and repeated courses of SCS were associated with the development of fibrosis, whereas transition to second-line drugs was not. Conclusion. SCS remain the first-line drugs in the treatment of sarcoidosis. The analysis performed allows us to recommend them after an observation period (if the patient’s condition allows it) and for at least 6 months. In case of exacerbation or recurrence of sarcoidosis after treatment with SCS, subsequent therapy with second-line drugs is more effective that a repeated course of SCS.