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Diffuse Lung Disease |

Glucocorticoid Toxicity Is Common in Sarcoidosis FREE TO VIEW

Christopher Donatelli, MD; Nauman Khan, MD; Jonathan Wiesen, MD; Adriano Tonelli, MD; Debasis Sahoo, MD; Daniel Culver, DO
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Cleveland Clinic, Cleveland, OH


Chest. 2015;148(4_MeetingAbstracts):417A. doi:10.1378/chest.2267014
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Abstract

SESSION TITLE: Non-IPF Diffuse Lung Disease

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AM

PURPOSE: Sarcoidosis is often treated for prolonged durations with glucocorticoids (GC) despite accumulation of toxicities. No study has systematically investigated the cumulative toxicities of GC use in sarcoidosis.

METHODS: We identified 154 patients whose initial diagnosis, sarcoidosis management, and majority of medical care were all provided in our health system from 2004 onwards. We measured all changes in steroid dose, on a daily basis, as well as the time to onset of several toxicities: diabetes, hypertension or hyperlipidemia (either new diagnosis or requirement for new medication in those with pre-existing disease); development of obesity; new ocular GC complication; new diagnosis of decreased bone density. Patients were followed to the present date or date of last encounter. A composite end-point was defined as meeting any of the toxicities.

RESULTS: We identified 154 patients; mean age at diagnosis was 47 ± 12 years; 82 (53 %) were female and 90 (58%) were Caucasian. The median (IQR) length of follow-up was 62 (20-95) months. 105 (68%) patients were treated with GC, with a mean of 2.1 ± 2.2 courses and median (IQR) exposure duration of 32 (12-82) weeks. The cumulative median (IQR) dose was 4.8 (1.8-7.2) g in prednisone-equivalents. The incidence of new toxicities for all patients was: diabetes, 16 (10%); obesity 28 (18%); hyperlipidemia, 18 (12%); hypertension, 40 (26%); cataracts/glaucoma, 28 (18%); decreased bone density, 22 (14%). In all, 87 patients (67 treated with GC and 20 not treated with GC, p=0.007) developed or experienced worsening of at least one GC toxicity, with an average of 1.2 ± 1.1 and 0.6 ± 0.8 conditions per patient treated and not treated with GC, respectively. Duration of GC therapy (R=0.33, p<0.001) and cumulative GC dose (R=0.25, p=0.002) were associated with the number of complications. Using multivariate Cox regression, factors affecting time to first event were age [HR per year 1.02 (95% CI: 1.00-1.04), p=0.034], any use of GC [HR 1.84 (95% CI: 1.08-3.14), p=0.026], and duration of GC [HR per year 1.18 (95% CI: 1.04-1.35, p=0.01].

CONCLUSIONS: The duration and cumulative GC dose in sarcoidosis patients are associated with the time to development or worsening of toxicities. The burden of GC toxicities on patients is likely under-appreciated in routine clinical practice.

CLINICAL IMPLICATIONS: Steroid-sparing alternatives should be considered earlier in treatment algorithms, and the widely accepted suggestion that steroids are first line for sarcoidosis therapy should be re-evaluated.

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

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