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Cumulative Dose and Duration of Glucocorticoid Use Are Associated With Metabolic Disorders in Sarcoidosis Patients FREE TO VIEW

Christopher Donatelli; Jonathan Wiesen; Adriano Tonelli; Debasis Sahoo; Daniel Culver, MS
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Cleveland Clinic Foundation, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):973A. doi:10.1378/chest.1993329
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SESSION TITLE: Topics in ILD and Lung Transplantation

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM

PURPOSE: Glucocorticoids (GC) are advocated as the main therapy for sarcoidosis. Many patients are treated with prolonged courses without the addition of steroid-sparing alternatives. Few studies have investigated the risk for systemic toxicities of GC in sarcoidosis.

METHODS: We reviewed a cohort of patients who were diagnosed for the first time with sarcoidosis and who had all their medical therapy provided within our health system beginning in 2004. The patients were followed to the present date or date of last visit. We conducted binary logistic and linear regressions to assess whether duration or total dose of GC were associated with a composite endpoint of steroid complications.

RESULTS: We analyzed 55 patients-the average age was 46 ± 12 years; 33 (60%) were female and 36 (65%) were Caucasian. Thirty-seven (67%) were treated with GC, with a mean of 2.6 ± 3.1 courses and a duration of 80 ± 105 weeks of therapy. The cumulative dose was 5.4 ±1.1gm in prednisone equivalents. The development of new or significantly worsening metabolic disorders in all patients was as follows: diabetes, 7 (13%); change in WHO obesity category, 17 (31%); hyperlipidemia, 7 (13%); hypertension, 14 (25%); glaucoma or cataracts, 12 (22%); osteoporosis, 14 (25%). Thirty seven patients (28 treated with GC, 9 who had not, p=0.034) developed or experienced worsening of at least one metabolic condition, with an average of 1.9 ± 1conditions per patient. The cumulative dose of GC was associated both with the composite end point (O.R. per 100 mg of prednisone equivalent 1.043, 95% CI: 1.011-1.077, p=0.009) and with the number of metabolic complications (R=0.42, p= 0.01). The duration of GC therapy was also significantly associated with the number of metabolic complications (R=0.41, p=0.001).

CONCLUSIONS: Both the duration and cumulative dose of GC therapy are associated with the development and worsening of known metabolic complications of GC treatment in sarcoidosis.

CLINICAL IMPLICATIONS: There are substantial under-appreciated risks of GC on comorbid diseases when they are used for treatment of sarcoidosis.

DISCLOSURE: The following authors have nothing to disclose: Christopher Donatelli, Jonathan Wiesen, Adriano Tonelli, Debasis Sahoo, Daniel Culver

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