Prednisone vs methotrexate in treatment naïve cardiac sarcoidosis.
Humans
Prednisone
/ therapeutic use
Fluorodeoxyglucose F18
/ therapeutic use
Methotrexate
/ therapeutic use
Positron Emission Tomography Computed Tomography
Retrospective Studies
Stroke Volume
Cardiomyopathies
/ diagnostic imaging
Radiopharmaceuticals
/ therapeutic use
Ventricular Function, Left
Sarcoidosis
/ diagnostic imaging
Positron-Emission Tomography
/ methods
Myocarditis
/ complications
Cardiac sarcoidosis
FDG PET/CT
immunosuppressants
methotrexate
prednisone
Journal
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
ISSN: 1532-6551
Titre abrégé: J Nucl Cardiol
Pays: United States
ID NLM: 9423534
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
12
07
2022
accepted:
19
10
2022
medline:
28
7
2023
pubmed:
15
1
2023
entrez:
14
1
2023
Statut:
ppublish
Résumé
Side effects limit the long-term use of glucocorticoids in cardiac sarcoidosis (CS), and methotrexate has gained attention as steroid sparing agent although the supporting evidence is poor. This study compared prednisone monotherapy, methotrexate monotherapy or a combination of both, in the reduction of myocardial Fluorine-18 fluorodeoxyglucose (FDG) uptake and clinical stabilization of CS patients. In this retrospective cohort study, 61 newly diagnosed and treatment naïve CS patients commenced treatment with prednisone (N = 21), methotrexate (N = 30) or prednisone and methotrexate (N = 10) between January 2010 and December 2017. Primary outcome was metabolic response on FDG PET/CT and secondary outcomes were treatment patterns, major adverse cardiovascular events, left ventricular ejection fraction, biomarkers and side effects. At a median treatment duration of 6.2 [5.7-7.2] months, 71.4% of patients were FDG PET/CT responders, and the overall myocardial maximum standardized uptake value decreased from 6.9 [5.0-10.1] to 3.4 [2.1-4.7] (P < 0.001), with no significant differences between treatment groups. During 24 months of follow-up, 7 patients (33.3%; prednisone), 6 patients (20.0%; methotrexate) and 1 patient (10.0%; combination group) experienced at least one major adverse cardiovascular event (P = 0.292). Left ventricular ejection fraction was preserved in all treatment groups. Significant suppression of cardiac FDG uptake occurred in CS patients after 6 months of prednisone, methotrexate or combination therapy. There were no significant differences in clinical outcomes during follow-up. These results warrant further investigation of methotrexate treatment in CS patients.
Sections du résumé
BACKGROUND
Side effects limit the long-term use of glucocorticoids in cardiac sarcoidosis (CS), and methotrexate has gained attention as steroid sparing agent although the supporting evidence is poor. This study compared prednisone monotherapy, methotrexate monotherapy or a combination of both, in the reduction of myocardial Fluorine-18 fluorodeoxyglucose (FDG) uptake and clinical stabilization of CS patients.
METHODS AND RESULTS
In this retrospective cohort study, 61 newly diagnosed and treatment naïve CS patients commenced treatment with prednisone (N = 21), methotrexate (N = 30) or prednisone and methotrexate (N = 10) between January 2010 and December 2017. Primary outcome was metabolic response on FDG PET/CT and secondary outcomes were treatment patterns, major adverse cardiovascular events, left ventricular ejection fraction, biomarkers and side effects. At a median treatment duration of 6.2 [5.7-7.2] months, 71.4% of patients were FDG PET/CT responders, and the overall myocardial maximum standardized uptake value decreased from 6.9 [5.0-10.1] to 3.4 [2.1-4.7] (P < 0.001), with no significant differences between treatment groups. During 24 months of follow-up, 7 patients (33.3%; prednisone), 6 patients (20.0%; methotrexate) and 1 patient (10.0%; combination group) experienced at least one major adverse cardiovascular event (P = 0.292). Left ventricular ejection fraction was preserved in all treatment groups.
CONCLUSIONS
Significant suppression of cardiac FDG uptake occurred in CS patients after 6 months of prednisone, methotrexate or combination therapy. There were no significant differences in clinical outcomes during follow-up. These results warrant further investigation of methotrexate treatment in CS patients.
Identifiants
pubmed: 36640249
doi: 10.1007/s12350-022-03171-6
pii: 10.1007/s12350-022-03171-6
doi:
Substances chimiques
Prednisone
VB0R961HZT
Fluorodeoxyglucose F18
0Z5B2CJX4D
Methotrexate
YL5FZ2Y5U1
Radiopharmaceuticals
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1543-1553Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.
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