Study Reveals Variation in Sarcoidosis Treatment Approaches Across Patients

Sarcoidosis is a multi-systemic disease of unknown etiology with a clinical presentation ranging from asymptomatic disease to organ failure. While some patients with sarcoidosis have spontaneous disease remission, others may require treatment for symptom management, organ involvement, and/or risk reduction of disease progression.

Data on sarcoidosis treatment in the U.S. is limited and inconsistent, with estimates for those requiring any treatment ranging from 23% among commercially insured patients to 78% in a rheumatology registry. Furthermore, real-world practice patterns of sarcoidosis treatment have been incomplete.

In a new Boston University Chobanian & Avedisian School of Medicine study, researchers have found that while sarcoidosis patients are being treated in concordance with guideline recommendations for treatment initiation, there is variation in practice in choice and sequence of treatments used.

"Treatment decisions in sarcoidosis can be complicated with not every patient requiring therapy and various therapy options available for those who do. Our findings highlight the need for better data to guide optimal treatment options and sequence," says senior author Divya Shankar, MD, clinical instructor of medicine at the school.

The researchers conducted a retrospective analysis using a large, multicenter claims and electronic health record database. They assessed whether patients diagnosed with sarcoidosis received either corticosteroids or nonsteroidal immunosuppressive medications in the year after diagnosis, and summarized treatment rates, sequence of prescribed medications and factors associated with receipt of treatment.

In the year following diagnosis, 43% of patients with sarcoidosis received treatment and 40% of treated patients received at least one nonsteroidal immunosuppressive medication with considerable variation in the choice and sequence of administration. "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," adds Shankar.

According to the researchers, the current findings underscore the need for future randomized trials and comparative effectiveness studies to help ascertain optimal treatment algorithms.

These findings appear online in the journal CHEST.

Funding for D. A. S. was provided by 1F32HL168959-01; This work was a product of the annual Pulmonary and Critical Care Research Fellows Crash Course supported by Boston University Pulmonary Center's Epidemiology, Clinical, Health Services, and Outcomes Research Group and National Institutes of Health T32 Biology of the Lung: A Multidisciplinary Program (HL007035).