Comparison of long-term outcomes in patients with cardiac sarcoidosis treated with different immunosuppressive drugs.

Background: We compared long-term clinical outcomes between patients with cardiac sarcoidosis (CS) who received no treatment (NT), steroid treatment (ST), disease-modifying anti-rheumatic drugs (DMARDs), or tumor necrosis factor alpha inhibitors (TNF).

Methods: Patients from SSM healthcare system's data warehouse were identified using ICD codes. Inclusion criteria included at least 6 months of follow-up. Outcomes studied were heart failure (HF) admissions, ventricular tachyarrhythmias (VTA), and pacemaker/defibrillator placement. Statistical analysis included multivariate logistic regression and Kaplan-Meier curves.

Results: We identified 198, 174, 66, and 19 patients in NT, ST, DMARDs, and TNF groups respectively. Mean age was 62.4, 60.2, 56, and 54.4 respectively. There was no significant difference in the rate of medical comorbidities including pulmonary sarcoidosis between the groups. Mean follow up was 92.3 months. Percent incidences of VTA were 17.5, 16.3, 12.5, and 5.6 (P 0.57) in the NT, ST, DMARDs and TNF groups respectively. DMARDs and TNF groups had a lower incidence of HF admission (43.9% and 36.8%) compared to NT and ST (59.1% and 59.2%). In the multivariate model, compared to NT group, the odds ratio for HF admission was 1.08 (CI: 0.70-1.65), 0.64 (0.36-1.14) and 0.45 (0.17-1.20) in the ST, DMARDs and TNF groups respectively. There was no significant difference in the rate of pacemaker/defibrillator placement between the groups.

Conclusion: In this retrospective study from a large healthcare system, CS patients treated with DMARDs or TNF had a trend for lower incidence of HF admission than those on NT or ST.