QJM Advance Access originally published online on April 4, 2006
QJM 2006 99(5):307-315; doi:10.1093/qjmed/hcl038
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Presenting characteristics as predictors of duration of treatment in sarcoidosis
From the 1University of Cincinnati Medical Center, Cincinnati, Ohio, 2Medical University of South Carolina, Charleston, South Carolina, 3Mount Sinai Medical Center, New York, New York, 4Georgetown University Medical Center, Washington DC, 5University of Pennsylvania and MCP-Hahnemann University Medical Centers, Philadelphia, Pennsylvania, and 6Clinical Trials and Surveys Corporation, Baltimore, Maryland, USA
Address correspondence to Dr R.P. Baughman, 1001 Holmes, Eden Ave, Cincinnati, OH 45267–0565, USA. email: bob.baughman{at}uc.edu
Received 29 July 2005 and in revised form 8 March 2006
Background: Some sarcoidosis patients never need therapy, but many still require therapy more than 2 years after initial diagnosis.
Aim: To determine what features at initial presentation are associated with treatment 2 years later.
Methods: Patients with biopsy-confirmed sarcoidosis enrolled in the ACCESS (A Case Control Etiologic Study of Sarcoidosis) study were initially evaluated within 6 months of diagnosis. Pulmonary function, chest X-ray and dyspnoea score were measured, and systemic therapy for the sarcoidosis recorded. Organ involvement was assessed using a standardized instrument. A subset (n = 215) were seen 18–24 months later for follow-up, and these patients constitute our study group.
Results: Ten patients had only received therapy before the first visit, with no further therapy, and were excluded from analysis. Of the remaining 205, 95 were not on therapy at the initial visit and 75 (79%) of these were never treated during follow-up. Of the 110 initially on therapy, 52 (47%) remained on therapy at follow-up. Other initial features associated with continued therapy were the level of dyspnoea and predicted vital capacity. On logistic regression, only dyspnoea and therapy at initial visit remained significant. Patients on systemic therapy at initial evaluation were more likely to be on therapy at follow-up (OR 3.6, p = 0.003). Neither ethnicity nor gender independently predicted therapy at follow-up.
Discussion: This study group represents a sample of newly diagnosed sarcoidosis patients. However, this is a referral population, and there was no set protocol for treatment. Use of systemic therapy within the first 6 months after diagnosis appears to be strongly associated with continued use of therapy 2 years later.
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