Fewer than 50% of patients with sarcoidosis treated within year of diagnosis

Key takeaways:

• Steroids alone was the most common treatment for the majority of this population.
• A shorter median time from diagnosis to receipt of steroids vs. nonsteroidal treatment was observed.

Less than half of patients with sarcoidosis had been treated by the 1-year mark since being diagnosed with the condition, according to results published in CHEST.

“Practice pattern variation was observed in the treatment of patients with sarcoidosis, particularly in relation to the use of nonsteroidal immunosuppressive medication and the sequence of these treatments, although factors associated with the likelihood of receiving therapy were in line with prior studies and guidelines,” Divya Shankar, MD, clinical instructor of medicine at Boston University School of Medicine, said in a press release.

Using the TriNetX database, Shankar and colleagues studied 13,330 patients (median age, 57 years; 57% women; 59% white) with a sarcoidosis diagnosis in 2016 to 2022 to determine treatment practice patterns with corticosteroids and/or nonsteroidal immunosuppressive medications at the 1-year mark since diagnosis.

Researchers also sought to find the factors that raised the likelihood for sarcoidosis treatment in this timeframe via multivariable logistic regression.

Notably, several medications fit under the study’s classification of nonsteroidal immunosuppressives: methotrexate, mycophenolate, leflunomide, hydroxychloroquine, cyclophosphamide, infliximab, adalimumab, azathioprine, rituximab and Janus kinase inhibitors.

Less than half (42.5%) of the total cohort had been treated by the 1-year mark. Steroids alone was the most common treatment for the majority of this population (60%), followed by treatment with both steroids and nonsteroid immunosuppressives (27%) and nonsteroidal immunosuppressives alone (13%), according to the study.

When evaluating nonsteroidal immunosuppressive prescriptions, researchers reported that methotrexate held the top spot with 20% of patients receiving this medication.

In terms of treatment timing, a shorter median time from diagnosis to receipt of steroids vs. nonsteroidal treatment was observed (25 days vs. 62 days), according to the study.

Researchers highlighted that a nonsteroidal immunosuppressive was the first medication for 25% of the treated group, but the more common first medication in the treated population was corticosteroids.

The second medication most commonly given varied based on involvement type. Hydroxychloroquine was this medication for patients with pulmonary or cutaneous involvement, whereas the study said adalimumab was the medication for patients with cardiac involvement and mycophenolate was the medication for patients with neurologic involvement.

Lastly, researchers observed a link between several factors and increased adjusted odds for sarcoidosis treatment:

• hypercalcemia (adjusted OR = 2.01; 95% CI, 1.64-2.48);
• hospitalization in previous year (aOR = 1.86; 95% CI, 1.68-2.07);
• baseline cardiac organ involvement (aOR = 1.6; 95% CI, 1.35-1.88);
• baseline ocular and/or neurologic organ involvement (aOR = 1.53; 95% CI, 1.09-2.14);
• interstitial lung disease (aOR = 1.48; 95% CI, 1.28-1.71);
• dyspnea (aOR = 1.28; 95% CI, 1.17-1.41);
• cough (aOR = 1.28; 95% CI, 1.15-1.42);
• baseline pulmonary organ involvement (aOR = 1.25; 95% CI, 1.15-1.35);
• fatigue (aOR = 1.2; 95% CI, 1.06-1.35); and
• Black race (vs. white race; aOR = 1.17; 95% CI, 1.07-1.27).

“Treatment decisions in sarcoidosis can be complicated with not every patient requiring therapy and various therapy options available for those who do,” Shankar said in the release. “Our findings highlight the need for better data to guide optimal treatment options and sequence.”

Reference:

• New study a first step in understanding current practice patterns of treatment for sarcoidosis. https://www.bumc.bu.edu/camed/2024/12/10/new-study-a-first-step-in-understanding-current-practice-patterns-of-treatment-for-sarcoidosis/. Published Dec. 10, 2024. Accessed Dec. 11, 2024.