# Prognostic impact of corticosteroid maintenance dose and re-escalation in patients with cardiac sarcoidosis

## TL;DR

This study found that following the recommended corticosteroid dose improves survival in patients with cardiac sarcoidosis, while deviating from it increases mortality risk.

## Contribution

The study provides evidence on the prognostic impact of corticosteroid maintenance doses and re-escalation in cardiac sarcoidosis.

## Key findings

- Patients on the recommended corticosteroid dose had better survival compared to low- and high-dose groups.
- Re-escalation of corticosteroids after achieving maintenance dose was linked to higher mortality in the high-dose group.
- Maintaining the recommended dose appears critical for better clinical outcomes in cardiac sarcoidosis.

## Abstract

Japanese guidelines recommend a corticosteroid maintenance dose of 5–10 mg/day for cardiac sarcoidosis (CS); however, the optimal dose remains unclear. This study aimed to evaluate the impact of maintenance dose and corticosteroid re-escalation on prognosis in patients with CS.

This multicentre retrospective cohort study used data from a Japanese nationwide CS registry. A total of 352 patients diagnosed according to the Japanese Circulation Society 2016 guideline and treated with oral corticosteroids were included. Patients were grouped by maintenance dose: low (<5.0 mg/day), recommended (5.0–10.0 mg/day) and high (>10.0 mg/day). Clinical outcomes were analysed. The main outcome was all-cause mortality.

The low-dose, recommended-dose and high-dose groups comprised 11% (n=40), 78% (n=276) and 10% (n=36) of patients, with mean maintenance doses of 2.2 mg/day, 6.7 mg/day and 16.2 mg/day, respectively. During a median follow-up of 5.12 years, 39 patients (11%) died. Kaplan-Meier survival analysis showed statistically better survival in the recommended dose group, with the high-dose group showing statistically significantly worse outcomes (log-rank p=0.012). Corticosteroid re-escalation occurred in 19% of patients (9% before and 11% after achieving maintenance dose). All-cause mortality was 8% in the recommended-dose group versus 25% in the low-dose and 17% in the high-dose groups. In univariable analyses, re-escalation after achieving maintenance was associated with mortality in the high-dose group (HR 4.34, 95% CI 1.24 to 98.3), whereas re-escalation before achieving maintenance was associated with mortality in the low-dose group (HR 19.41, 95% CI 2.71 to 138.5).

A recommended maintenance dose of corticosteroids was associated with better prognosis in patients with CS. Achieving and maintaining this dose appears critically important in clinical management.