Brooks Lisbeth, Kivlin William, Mohananey Divyanshu, Sabchyshyn Viktoriya, Putman Michael
Division of Rheumatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Rheumatology (Oxford). 2025 Jun 1;64(6):3303-3308. doi: 10.1093/rheumatology/keae692.
We aimed to evaluate the comparative efficacy of disease-modifying antirheumatic drugs (DMARDs) for patients with cardiac sarcoidosis.
We performed a retrospective cohort study of new users of methotrexate, mycophenolate or azathioprine for sarcoidosis using the US-based TriNetX electronic health records database from 2008 to 2023. Hazard ratios were calculated using inverse probability of treatment weighted Cox proportional hazards regressions to compare the efficacy of DMARDs with respect to delaying major adverse cardiac events among patients with cardiac sarcoidosis and preventing cardiac sarcoidosis from developing among patients with non-cardiac sarcoidosis.
Among 3441 patients with sarcoidosis, 601 were defined as cardiac sarcoidosis and 2840 as non-cardiac sarcoidosis. The average age of the cohort was 52.1 years (standard deviation 11.9 years) and the majority were female (55.9%) and white (50.0%). Among patients with cardiac sarcoidosis at baseline, the risk of serious cardiac outcomes was similar for patients who initiated therapy with mycophenolate mofetil (HR 0.83, 95% CI 0.43-1.59) or azathioprine (HR 0.74, 95% CI 0.29-1.89) as compared with methotrexate. Among patients who did not have cardiac sarcoidosis at baseline, the risk of developing cardiac sarcoidosis was similar for patients who initiated therapy with mycophenolate mofetil (HR 1.11, 95% CI 0.46-2.66) and azathioprine (HR 0.54, 95% CI 0.15-1.91) as compared with 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.
A strategy of methotrexate had a favorable safety profile in terms of infection risk and may be favored over azathioprine or mycophenolate mofetil for patients with sarcoidosis or cardiac sarcoidosis.
我们旨在评估改善病情抗风湿药（DMARDs）对心脏结节病患者的相对疗效。
我们使用美国的TriNetX电子健康记录数据库，对2008年至2023年期间新使用甲氨蝶呤、霉酚酸酯或硫唑嘌呤治疗结节病的患者进行了一项回顾性队列研究。使用治疗加权Cox比例风险回归的逆概率计算风险比，以比较DMARDs在延迟心脏结节病患者发生主要不良心脏事件以及预防非心脏结节病患者发生心脏结节病方面的疗效。
在3441例结节病患者中，601例被定义为心脏结节病，2840例为非心脏结节病。该队列的平均年龄为52.1岁（标准差11.9岁），大多数为女性（55.9%）和白人（50.0%）。在基线时患有心脏结节病的患者中，与甲氨蝶呤相比，开始使用霉酚酸酯（风险比0.83，95%置信区间0.43 - 1.59）或硫唑嘌呤（风险比0.74，95%置信区间0.29 - 1.89）治疗的患者发生严重心脏结局的风险相似。在基线时没有心脏结节病的患者中，与甲氨蝶呤相比，开始使用霉酚酸酯（风险比1.11，95%置信区间0.46 - 2.66）和硫唑嘌呤（风险比0.54，95%置信区间0.15 - 1.91）治疗的患者发生心脏结节病的风险相似。霉酚酸酯（风险比1.83，95%置信区间1.10 - 3.05）和硫唑嘌呤（风险比1.32，95%置信区间0.92 - 1.89）会增加感染风险。
就感染风险而言，甲氨蝶呤策略具有良好的安全性，对于结节病或心脏结节病患者，可能比硫唑嘌呤或霉酚酸酯更受青睐。
