ArticleOpen heart2026
Prognostic impact of corticosteroid maintenance dose and re-escalation in patients with cardiac sarcoidosis.
Article in Open heart, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundJapanese guidelines recommend a corticosteroid maintenance dose of 5-10 mg/day for cardiac sarcoidosis (CS); however, the optimal dose remains unclear. This study aimed to evaluate the impact of maintenance dose and corticosteroid re-escalation on prognosis in patients with CS.
methodsThis multicentre retrospective cohort study used data from a Japanese nationwide CS registry. A total of 352 patients diagnosed according to the Japanese Circulation Society 2016 guideline and treated with oral corticosteroids were included. Patients were grouped by maintenance dose: low (<5.0 mg/day), recommended (5.0-10.0 mg/day) and high (>10.0 mg/day). Clinical outcomes were analysed. The main outcome was all-cause mortality.
resultsThe low-dose, recommended-dose and high-dose groups comprised 11% (n=40), 78% (n=276) and 10% (n=36) of patients, with mean maintenance doses of 2.2 mg/day, 6.7 mg/day and 16.2 mg/day, respectively. During a median follow-up of 5.12 years, 39 patients (11%) died. Kaplan-Meier survival analysis showed statistically better survival in the recommended dose group, with the high-dose group showing statistically significantly worse outcomes (log-rank p=0.012). Corticosteroid re-escalation occurred in 19% of patients (9% before and 11% after achieving maintenance dose). All-cause mortality was 8% in the recommended-dose group versus 25% in the low-dose and 17% in the high-dose groups. In univariable analyses, re-escalation after achieving maintenance was associated with mortality in the high-dose group (HR 4.34, 95% CI 1.24 to 98.3), whereas re-escalation before achieving maintenance was associated with mortality in the low-dose group (HR 19.41, 95% CI 2.71 to 138.5).
conclusionsA recommended maintenance dose of corticosteroids was associated with better prognosis in patients with CS. Achieving and maintaining this dose appears critically important in clinical management.
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