Durable remission of cardiac sarcoidosis following discontinuation of methotrexate: A prospective cohort study.

INTRODUCTION

Cardiac sarcoidosis (CS) treatment is challenging due to limited data. Key unknowns include optimal therapies and treatment duration. Data from pulmonary sarcoidosis suggest three disease phenotypes: acute (<1-2 years), chronic, and advanced. Our previous research showed that after a one-year course of corticosteroids, 1/3 of patients did not relapse (acute treatment phenotype), while 2/3 did. This study aims to investigate relapse rates in patients after discontinuation of Methotrexate (MTX).

METHODS

This is a single-centre sub-study of the Cardiac Sarcoidosis Multi-Center Prospective Cohort Study (CHASM-CS; NCT01477359). A follow-up PET scan 6-12 months was performed post-MTX discontinuation to assess for relapse. Patients without cardiac relapse were followed clinically thereafter with annual ECGs and echocardiograms.

RESULTS

Twelve consecutive MTX responders (mean age: 53.6 ± 8.2 years, 66.6 % female) were included. Mean MTX treatment duration was 44.6 ± 17.6 months. One patient (8.3 %) had recurrent cardiac and extracardiac sarcoidosis, presenting with ventricular tachycardia storm 6.1 months after stopping MTX. Four patients (33.3 %) had recurrent extracardiac sarcoidosis only. Eleven non-cardiac relapsers were followed for an average of 24.9 ± 12.3 months with no adverse clinical events or late relapses.

CONCLUSIONS

In 11/12 (91.7 %) patients, CS remained in remission after discontinuation of MTX. These results need replication in larger populations.