Bindra Jas, Chopra Ishveen, Hayes Kyle, Niewoehner John, Panaccio Mary P, Wan George J
Falcon Research Group, North Potomac, MD.
Manticore Consultancy, Bethesda, MD.
J Health Econ Outcomes Res. 2022 Apr 20;9(1):90-100. doi: 10.36469/jheor.2022.33295. eCollection 2022.
Sarcoidosis, an inflammatory systemic granulomatous disease, affects multiple organs and has a diverse clinical course. Repository corticotropin injection (RCI) is an effective treatment for advanced symptomatic sarcoidosis. Since sarcoidosis affects patients differently, treatment response may vary by patient demographic, clinical, and treatment-related characteristics and physician specialty. However, there is a paucity of literature regarding predictors of sarcoidosis treatment response. This study investigated predictors of response to RCI treatment. Post-hoc analysis was conducted using data from a previously published retrospective cross-sectional chart review study among symptomatic sarcoidosis patients ≥18 years of age previously treated with RCI. Outcome improvement 3 months post-RCI treatment was based on the clinician's subjective evaluation and analyzed using adjusted logistic regression. The most influential predictors for each outcome were based on statistical significance (<.05) and the strength of the relationship assessed by the standardized β coefficients. The top predictors of outcome improvements were as follows. (1) improvement in influenced by complete RCI compliance, moderate overall symptom severity, and presence of extrapulmonary sites; and (2) improvement in influenced by age, shorter duration since sarcoidosis diagnosis, and complete RCI compliance. (1) improvement influenced by mild weight loss, mild wheezing/coughing, and non-African American race; (2) reduction in influenced by moderate overall symptom severity, mild wheezing/coughing, and mild weight loss; and (3) reduction in influenced by physician specialty, completing a course of RCI treatment, and moderate-to-severe night sweats. (1) reduction in influenced by physician specialty and moderate-to-severe fatigue; and (2) improvement in influenced by shorter duration since sarcoidosis diagnosis, moderate-to-severe wheezing/coughing, and complete RCI compliance. was influenced by physician specialty, moderate-to-severe shortness of breath, and comedication use before RCI. RCI may be a better treatment option for patients with more severe disease, primarily those presenting with symptoms. Complete compliance with RCI treatment may improve patients' health and quality of life. Understanding factors that influence RCI effectiveness across different treatment outcomes in real-world clinical practice is important for designing optimal sarcoidosis treatment strategies.
结节病是一种炎症性全身性肉芽肿疾病，可累及多个器官，临床病程多样。促肾上腺皮质激素注射剂（RCI）是治疗晚期症状性结节病的有效方法。由于结节病对患者的影响各不相同，治疗反应可能因患者的人口统计学、临床和治疗相关特征以及医生专业而有所差异。然而，关于结节病治疗反应预测因素的文献较少。本研究调查了RCI治疗反应的预测因素。使用先前发表的一项针对年龄≥18岁、曾接受RCI治疗的症状性结节病患者的回顾性横断面图表审查研究的数据进行事后分析。RCI治疗后3个月的结果改善基于临床医生的主观评估，并使用调整后的逻辑回归进行分析。每个结果最具影响力的预测因素基于统计学显著性（<.05）以及标准化β系数评估的关系强度。结果改善的主要预测因素如下：（1） 改善受RCI完全依从性、总体症状中度严重程度和肺外部位的存在影响；（2） 改善受年龄、结节病诊断后病程较短和RCI完全依从性影响。（1） 改善受轻度体重减轻、轻度喘息/咳嗽和非非裔美国人种族影响；（2） 降低受总体症状中度严重程度、轻度喘息/咳嗽和轻度体重减轻影响；（3） 降低受医生专业、完成RCI治疗疗程和中度至重度盗汗影响。（1） 降低受医生专业和中度至重度疲劳影响；（2） 改善受结节病诊断后病程较短、中度至重度喘息/咳嗽和RCI完全依从性影响。 受医生专业、中度至重度呼吸急促和RCI治疗前合并用药的影响。RCI可能是病情更严重患者（主要是出现症状的患者）的更好治疗选择。完全依从RCI治疗可能改善患者的健康和生活质量。了解在实际临床实践中影响RCI在不同治疗结果中的有效性的因素对于设计最佳结节病治疗策略很重要。
