STEROIDS FOR SARCOIDOSIS- DO THEY REALLY WORK?

Aims and objectivesCorticosteroids remain the mainstay of therapy in sarcoidosis. At present despite extensive use there is limited evidence of long term survival benefit.1 We aimed to interrogate a large cohort of patients diagnosed with sarcoidosis in order to identify measures of active disease, predictors for progression and response to standard treatment; particularly with regard to physiological measures.MethodsClinical data from 325 patients with sarcoidosis was recorded retrospectively including; age at diagnosis, gender, Scadding CXR stage at presentation, presence of Erythema Nodosum (EN), baseline inflammatory markers, immunoglobulin levels, liver function, and pulmonary function. There was a minimum follow up of 2 years for all patients. Data was available for subgroups at 5 and 10 years. The primary outcome measure was the physiological response to treatment prescribed by a single physician based on ATS/ERS/WASOG criteria. Treatment was defined as requiring oral corticosteroids for 6 months or more.ResultsPatients were characterised into four groups dependent on scadding stage. Co-variate analysis based on the clinical need for treatment and presence of abnormal pulmonary function at diagnosis was performed. Overall the treatment rate was 50.1% in this cohort. Initial investigation documented patients treated with steroids had a smaller average percentage change in FVC at 2 years compared with those not treated when corrected for other variables. Treatment group mean=11.78%, Un-treated group 25.44%, p=0.0056. Treatment with steroids was not shown to have a statistically significant effect on rate of change of transfer factor when corrected for other co-variables.ConclusionThis study has documented benefit in the use of steroids to prevent decline in FVC over a 2 year period. Further work in terms of persistent of disease activity from peripheral biomarkers is ongoing and may shed further insight in predicting fibrotic phenotypes.ReferenceJC Grutters, et al. Corticosteroid treatment in sarcoidosis. ERJ2006;28:627–36.