Cardiac sarcoidosis (CS) is a major cause of morbidity and mortality in patients with systemic sarcoidosis. Steroid sparing agents are increasingly used, despite lack of randomized trials or published guidelines to direct treatment.
This retrospective study included 77 patients with CS treated with prednisone monotherapy (n=32) or a combination with mycophenolate mofetil (MMF) (n=45) between 2003 and 2018. Baseline characteristics and clinical outcomes were evaluated.
Patients were mean age 53±11 years at CS diagnosis, 66.2% male and 35.1% Black. Total exposure to maximum prednisone dose (initial prednisone dose x days at dose) was lower in the combination therapy group (1440 mg [1200, 2760] vs 2710 mg [1200, 5080]; p = 0.06). On F-fluorodeoxyglucose (FDG) positron emission tomography, both groups demonstrated a significant decrease in cardiac maximum standardized uptake value post-treatment: median decrease 3.9 (IQR 2.7, 9.0; p=0.002) and 2.9 (IQR 0, 5.0; p=0.001) for prednisone monotherapy and combination therapy, respectively. Most patients experienced improvement or complete resolution in qualitative cardiac FDG uptake (92.3% and 70.4% for prednisone and combination therapy groups, respectively). MMF was well tolerated.
MMF in combination with prednisone for treatment of CS may minimize corticosteroid exposure and reduce cardiac inflammation without significant adverse effects.

Copyright © 2021. Published by Elsevier Inc.