¹Department Innere Medizin/Klinik für Hämatologie, Onkologie und Rheumatologie, Heidelberg
²Thoraxklinik Heidelberg gGmbH, Universitätsklinikum Heidelberg, Heidelberg
³Universitätsklinikum Düsseldorf, Klinik für Rheumatologie, Düsseldorf

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Introduction: Even if cardiac sarcoidosis occurs in only 5–10% of all cases with systemic sarcoidosis [1], it is associated with challenges in diagnosis, therapy and treatment follow-up as the majority of patients have multi-organ disease and immunosuppressive treatment mostly relies on case series and individual expert decisions [2]. Therefore, the present study shall provide more comprehensive and comparing data supporting the use of conventional synthetic (cs-) and biologic (b-) disease-modifying anti-rheumatic drugs (DMARD) in the treatment of cardiac sarcoidosis.

Methods: In total, 35 patients with cardiac sarcoidosis meeting the definite or highly probable diagnostic criteria of both Heart Rhythm Society (HRS) and Japanese Cardiology Society (JCS) were analyzed retrospectively. Both clinical, laboratory and echocardiographic parameters as well as adverse events of the given therapy were compared before and 3-6 months after initiating immunosuppressive treatment of active cardiac sarcoidosis with either azathioprine, methotrexate, cyclophosphamide or infliximab.

Results: After 3–6 months, immunosuppressive treatment with azathioprine, methotrexate, cyclophosphamide and infliximab showed significant increase of left ventricular ejection fraction in echocardiography. Values of N-terminal pro-B-type natriuretic peptide, troponin T, soluble interleukin-2-receptor and c-reactive protein were initially increased and showed a significant decrease under treatment. Patients’ and physicians’ global assessment revealed a stable or improved overall clinical function. Dose of prednisolone could be tapered significantly. Adverse events occurred only in a small number of patients.

Conclusion: Our data support treatment of cardiac sarcoidosis with both csDMARD and bDMARD leading to an improved cardiac function, decreased disease activity parameters and stable or improved overall clinical disease burden, significantly reduced dose of administered prednisolone accompanied with few adverse events.

Disclosures: There was no conflict of interest of any of the authors.

References

[1] Kouranos V, Sharma R. Cardiac sarcoidosis: state-of-the-art review. Heart. 2021 Oct;107(19):1591-9. DOI: 10.1136/heartjnl-2019-316442
[2] Lehtonen J, Uusitalo V, Pöyhönen P, Mäyränpää MI, Kupari M. Cardiac sarcoidosis: phenotypes, diagnosis, treatment, and prognosis. Eur Heart J. 2023 May 1;44(17):1495-510. DOI: 10.1093/eurheartj/ehad067