Abstract 12678: Steroids versus Steroid-Sparing Agents in Cardiac Sarcoidosis: A Retrospective Analysis of Clinical Outcomes

Introduction: Equipoise remains on whether initial therapy for cardiac sarcoidosis (CS) should consist of corticosteroids alone or include steroid-sparing agents (SSAs). This study retrospectively assessed outcomes of CS patients initially treated with prednisone only versus SSAs +/- prednisone. Hypothesis: We hypothesized that initial therapy inclusive of SSAs would be associated with reduced adverse outcomes. Method: We performed a retrospective review of CS patients seen at the MUSC Pearlstine Sarcoidosis Center of Excellence in the preceding year. The patients were divided into two cohorts: the prednisone group was defined as patients taking only prednisone for > 3 months as initial therapy of CS. The SSA group was defined as patients taking SSAs (methotrexate or MMF) +/- prednisone within three months of initial therapy for CS. Cardiovascular outcomes after CS diagnosis were compared between the groups. Results: We included 107 patients for analysis (37 prednisone; 70 SSA (53% methotrexate, 47% MMF)). Patients in the SSA group were 77% less likely to develop heart failure with reduced ejection fraction (RR 0.23, p=0.0001), 72% less likely to develop heart failure with preserved ejection fraction (RR 0.28, p=0.001), 62% less likely to be hospitalized for heart failure (RR 0.38, p=0.02), 77% less likely to be hospitalized for ventricular tachycardia (RR 0.23, p=0.01), 60% less likely to develop ventricular arrhythmias (RR 0.4, p=0.003), 80% less likely to experience an ICD shock (RR 0.2, p=0.005), and 50% less likely to develop heart block requiring a pacemaker (RR 0.5, p=0.01) than the prednisone group (see Figure). Conclusions: In this study of CS patients, early therapy inclusive of SSAs was associated with significantly reduced heart failure and arrhythmia risks. Our study suggests that early therapy for CS should include SSAs. Future investigations in these cohorts will focus on between-group comparisons to assess for potential confounding factors.