Introduction: There has been a recent paradigm shift in the treatment of sarcoidosis that emphasizes complete withdrawal of corticosteroid therapy. 

Objectives: We evaluated factors associated with successful discontinuation of corticosteroids in sarcoidosis patients treated at 6 US medical centers.

Materials and Methods: We analyzed two outcomes for corticosteroid-tapering regimens: A) Corticosteroid-free outcome: corticosteroids were successfully discontinued for at least 6 months; and B) Sarcoidosis exacerbation: Worsening sarcoidosis requiring increased doses of a sarcoidosis medication and/or addition of a sarcoidosis medication. All other potential outcomes of corticosteroid-tapering regimens were not analyzed.

Results: We analyzed 1049 corticosteroid-tapering regimens for the treatment of sarcoidosis in 686 patients. Most patients were black (57%) and female (56%). Mean (SD) number of organs involved with sarcoidosis was 2.5 (1.4). 421/1049 (40%) of the regimen outcomes were corticosteroid-free whereas 628/1049 (60%) were sarcoidosis exacerbations. In univariate analyses (Table 1), there was no difference in corticosteroid-free outcomes in terms of gender, Scadding stage, or patient age. Corticosteroid-free outcomes were less common in Blacks than Whites (37% vs 46%, p=006). Patients with corticosteroid-free outcomes had less organs involved than those with sarcoidosis exacerbations (2.47+1.4 vs 2.79 + 1.6, p<0.001). A corticosteroid-alone taper (without any other sarcoidosis medications) had less corticosteroid-free outcomes than regimens with >1 concomitant agent (33%,168/504 vs 46%,253/545, p <.001). Regimens with hydroxychloroquine, methotrexate, infliximab, all had a statistically higher percentage of corticosteroid-free outcomes than corticosteroid-alone regimens. In a multi-logistic regression analysis (Table 2), corticosteroid-free outcomes were less frequent in Blacks and corticosteroid-alone regimens. Corticosteroid-free outcomes were more common when lung or eye was the treated organ and in patients with longer disease duration.

Conclusions: Successful discontinuation of corticosteroids was less common in corticosteroid-alone tapering regimens than regimens containing at least one additional sarcoidosis medication. Blacks were less likely to have corticosteroids successfully discontinued than Whites.