The effect of corticosteroids on quality of life in a sarcoidosis clinic: the results of a propensity analysis.

BACKGROUND: Both sarcoidosis and its treatment may worsen health related quality of life (HRQoL). We performed a propensity analysis of sarcoidosis-specific HRQoL patient reported outcome measures (PRO) to disentangle the effects of sarcoidosis and corticosteroid therapy on HRQoL in sarcoidosis outpatients. METHODS: Consecutive outpatient sarcoidosis patients were administered modules from two sarcoidosis-specific HRQoL PROs: the Sarcoidosis Health Questionnaire (SHQ) and the Sarcoidosis Assessment Tool (SAT). Patients were divided into those that received ≤500 mg of prednisone (PRED-LOW) versus >500 mg of prednisone (PRED-HIGH) over the previous year. SAT and SHQ scores were initially compared in the two corticosteroid groups. Then a multivariate analysis was performed using a propensity score analysis adjusted for race, age, gender and the severity of illness. RESULTS: In the unadjusted analysis, the PRED-HIGH group demonstrated the following worse HRQoL scores compared to the LOW-PRED group: SHQ Daily (p = 0.02), SAT satisfaction (p = 0.03), SAT daily activities (p = 0.03). In the propensity analysis, the following domains demonstrated worse HRQoL in the PRED-HIGH group than the PRED-LOW group: SAT fatigue (p < 0.0001), SAT daily activities (p = 0.03), SAT satisfaction (p = 0.03). All these differences exceeded the established minimum important difference for these SAT domains. The SHQ Physical score appeared to demonstrate a borderline improved HRQoL in the PRED-HIGH versus the PRED-LOW group (p = 0.05).). In a post-hoc exploratory analysis, the presence of cardiac sarcoidosis may have explained the quality of life differences between the two corticosteroid groups. CONCLUSIONS: Our cohort of sarcoidosis clinic patients who received ≤500 mg of prednisone in the previous year had an improved HRQoL compared to patients receiving >500 mg on the basis of two sarcoidosis-specific PROs after adjusting for severity of illness. These data support the need to measure HRQoL in sarcoidosis trials, and suggest that the search should continue for effective alternative medications to corticosteroids.

Mortality of intrathoracic sarcoidosis in referral vs population-based settings: influence of stage, ethnicity, and corticosteroid therapy.

STUDY OBJECTIVES: To compare the sarcoidosis mortality in referral settings (RS) and population-based settings (PS), and to identify the contribution of stage, ethnicity, and corticosteroid therapy (CST) to their disparate outcomes. DESIGN: All observational studies identified in a MEDLINE search and bibliographic review published in the English language since 1960 dealing with the course and prognosis of sarcoidosis in large, unsorted, adult, ambulatory RS and PS providing long-term follow-up were reviewed and subjected to meta-analysis. MEASUREMENTS AND RESULTS: Sarcoidosis mortality in RS (4.8%), in which 17% of patients had the most unfavorable prognosis as judged by stage (stage III), was 10-fold that reported in PS (0.5%), in which 11% of patients were identified at this stage. The magnitude of this disparity could not be accounted for solely by adverse selection, as indicated by stage or by ethnicity. Patients in RS received CST with sevenfold the frequency of PS, and its provision was highly correlated with stage-normalized mortality. CONCLUSION: The prognosis of patients with intrathoracic sarcoidosis in PS is far more favorable than that obtained in RS. Sarcoidosis mortality is largely independent of ethnicity. The possibility cannot be excluded that excessive employment of CST may unfavorably influence the long-term course of the disease in some individuals.