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The following is a summary of “Comparative effectiveness of disease modifying antirheumatic drugs for patients with cardiac sarcoidosis,” published in the December 2024 issue of Rheumatology by Brooks et al. 

Researchers conducted a retrospective study to evaluate the comparative efficacy of disease modifying antirheumatic drugs (DMARDs) for patients with cardiac sarcoidosis. 

They performed a retrospective cohort study using the US-based TriNetX electronic health records database (2008–2023) to analyze new users of methotrexate, mycophenolate, or azathioprine for sarcoidosis. Hazard ratios (HR) were calculated using inverse probability of treatment weighted Cox proportional hazards regressions to compare DMARD efficacy in delaying major adverse cardiac events in patients with cardiac sarcoidosis and preventing cardiac sarcoidosis in patients with non-cardiac sarcoidosis. 

The results showed that among 3,441 patients with sarcoidosis, 601 had cardiac sarcoidosis, and 2,840 had non-cardiac sarcoidosis. The average age was 52.1 years (SD 11.9), with 55.9% female and 50.0% white. For patients with cardiac sarcoidosis, the risk of serious cardiac outcomes was similar for those on mycophenolate mofetil (HR 0.83, 95% CI 0.43–1.59) and azathioprine (HR 0.74, 95% CI 0.29–1.89) compared to methotrexate. For those without cardiac sarcoidosis at baseline, the risk of developing it was similar for mycophenolate mofetil (HR 1.11, 95% CI 0.46–2.66) and azathioprine (HR 0.54, 95% CI 0.15–1.91) compared to methotrexate. Mycophenolate mofetil (HR 1.83, 95% CI 1.10–3.05) and azathioprine (HR 1.32, 95% CI 0.92–1.89) increased the risk of infection. 

Investigators concluded that methotrexate demonstrated a favorable safety profile regarding infection risk. It was preferred over azathioprine and mycophenolate mofetil for patients with sarcoidosis or cardiac sarcoidosis. 

Source: academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keae692/7933199