Location
Philadelphia, PA
Start Date
11-5-2022 1:00 PM
End Date
11-5-2022 4:00 PM
Description
INTRODUCTION:
Corticosteroids are the mainstay treatment for cardiac sarcoidosis (CS), which manifests clinically in about 5% of sarcoid patients. Current comparisons of steroid regimens in CS focus on starting dose and rarely describe taper rates or expected cumulative exposure. This study characterizes several prednisone regimens for CS to strengthen frameworks for defining treatment goals.
METHODS:
We queried a registry of 1,403 patients referred to the Hospital of the University of Pennsylvania for positron emission tomography (PET) investigation of CS. We performed chart reviews of 98 patients with myocardial inflammation on initial PET who were treatment naïve, initiated on prednisone for CS between 2008 and 2019, and whose dose was known throughout a 52-week period following treatment initiation. Patients were stratified by starting dose into low-dose (LD, n=22) (<30 mg/day), moderate-dose (MD, n=52) (30-49 mg/day), and high-dose (HD, n=24) (≥50 mg/day) groups. We used one-way ANOVA to assess differences in cumulative exposure. Taper rate was derived using a quadratic mixed model. We included fixed effects for week number, starting dose, and their interaction and a random intercept term to account for correlations from repeated measures per patient. We performed post-hoc comparison of estimated marginal means to compare taper rates.
RESULTS:
Cumulative exposure over 52 weeks (mean±SD) increased proportionally with starting dose: 5,413±2,446 mg vs. 6,752±2,748 mg vs. 10,322±3,624 mg in LD, MD, and HD groups, respectively (F2, 95 = 18.3, p<10-7). Taper rate (mean [95% CI]) was inversely proportional to starting dose: -0.223 [-0.252, -0.194] mg/week vs. -0.492 [-0.511, - 0.474] mg/week vs. -0.758 [-0.785, -0.730] mg/week in LD, MD, and HD groups, respectively (p<0.001).
CONCLUSIONS:
Starting dose is related to cumulative exposure and taper rate. Future studies should investigate the association between cumulative exposure and adverse events and the relationship between taper rate and disease relapse.
Embargo Period
6-1-2022
Included in
Characterizing Prednisone Regimens for Treatment of Cardiac Sarcoidosis
Philadelphia, PA
INTRODUCTION:
Corticosteroids are the mainstay treatment for cardiac sarcoidosis (CS), which manifests clinically in about 5% of sarcoid patients. Current comparisons of steroid regimens in CS focus on starting dose and rarely describe taper rates or expected cumulative exposure. This study characterizes several prednisone regimens for CS to strengthen frameworks for defining treatment goals.
METHODS:
We queried a registry of 1,403 patients referred to the Hospital of the University of Pennsylvania for positron emission tomography (PET) investigation of CS. We performed chart reviews of 98 patients with myocardial inflammation on initial PET who were treatment naïve, initiated on prednisone for CS between 2008 and 2019, and whose dose was known throughout a 52-week period following treatment initiation. Patients were stratified by starting dose into low-dose (LD, n=22) (<30 mg>/day), moderate-dose (MD, n=52) (30-49 mg/day), and high-dose (HD, n=24) (≥50 mg/day) groups. We used one-way ANOVA to assess differences in cumulative exposure. Taper rate was derived using a quadratic mixed model. We included fixed effects for week number, starting dose, and their interaction and a random intercept term to account for correlations from repeated measures per patient. We performed post-hoc comparison of estimated marginal means to compare taper rates.
RESULTS:
Cumulative exposure over 52 weeks (mean±SD) increased proportionally with starting dose: 5,413±2,446 mg vs. 6,752±2,748 mg vs. 10,322±3,624 mg in LD, MD, and HD groups, respectively (F2, 95 = 18.3, p<10-7). Taper rate (mean [95% CI]) was inversely proportional to starting dose: -0.223 [-0.252, -0.194] mg/week vs. -0.492 [-0.511, - 0.474] mg/week vs. -0.758 [-0.785, -0.730] mg/week in LD, MD, and HD groups, respectively (p<0.001).
CONCLUSIONS:
Starting dose is related to cumulative exposure and taper rate. Future studies should investigate the association between cumulative exposure and adverse events and the relationship between taper rate and disease relapse.