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Symptomatic sarcoidosis more likely to require treatment

New data suggest that patients with symptomatic sarcoidosis are more likely to require treatment, have a greater number of organs involved in their disease and have worse health-related quality of life than their asymptomatic counterparts.

From 2011 to 2018, researchers conducted a retrospective analysis of 660 patients with confirmed sarcoidosis seen at a U.S. sarcoidosis clinic. Information on symptom onset, including the absence of symptoms, was obtained through medical records and patient report.

Ninety-eight percent of patients had pulmonary sarcoidosis and 73% were symptomatic. The median time from symptom onset to most recent follow-up was more than 6 years.

Fifty-six percent of the entire cohort used anti-sarcoidosis therapy at some point, with 42% using it within the last year. Most patients who received therapy used corticosteroids.

Results showed that significantly more patients with symptoms vs. without symptoms received any treatment ever (63% vs. 37%; P < .001), any corticosteroid treatment ever (55% vs. 32%; P < .001) and any noncorticosteroid treatment ever (14% vs. 6%; P = .01). Similar results were seen for any therapy in the most recent year (48% vs. 26%; P < .001), any corticosteroid treatment in the most recent year (38% vs. 23%; P < .001) and any non-corticosteroid treatment in the most recent year (9% vs. 3%; P = .01).

Organ involvement and quality of life

Patients with symptoms also had more organs involved with sarcoidosis than those without symptoms (P < .001), including an increased percentage of skin (20% vs. 7%; P < .001), eye (18% vs. 7%; P < .001) and neurologic involvement (6% vs. 1%; P = .004). The percentage of cardiac sarcoidosis, however, did not differ significantly between those with vs. without symptoms.

The researchers gauged health-related quality of life among patients using the Sarcoidosis Assessment Tool (SAT). The researchers found that symptomatic patients had worse scores for daily activities (P = .007), satisfaction (P = .006) and fatigue (P = .022). These differences in the mean scores in all three domains between patients with vs. without symptoms also “exceeded the minimum clinically important difference for that domain,” the researchers wrote.

After adjustment for age, sex, race and the time between presentation to most recent follow-up visit, the relationship persisted between symptoms and greater need for any sarcoidosis treatment ever and in the previous year; corticosteroid treatment ever and in the most recent year and noncorticosteroid treatment ever and in the most recent year. The same was true for skin involvement and worse health-related quality of life in the daily activities, satisfaction and fatigue domains of the SAT.

Potential implications

Demographically, there were more black patients and fewer white patients in the symptomatic group, but there were no other significant differences in age, sex, time between presentation and most recent follow-up and time between presentation and most recent imaging study between groups.

The researchers noted that the study is not without limitations. These include the potential for errors in the estimate of symptom onset due to poor patient recall or inaccurate physician assessment, a lack of protocolized treatment decisions and the fact that 98% of patients had pulmonary sarcoidosis as opposed to nonpulmonary sarcoidosis. The cohort that underwent SAT assessment was also slightly younger and had slightly less lung involvement. Additionally, the study was performed at one center and is therefore not generalizable to other populations.

However, the researchers noted that their findings may have important ramifications.

“Not only may these results have prognostic implications, but they may suggest a consideration of novel long-term clinical endpoints for future clinical trials,” they wrote. – by Melissa Foster

Disclosures: One author reports he is a consultant for Biogen. All other authors report no relevant financial disclosures.