Autoinflammatory & rare systemic diseases
Comparative effectiveness of disease-modifying antirheumatic drugs for patients with cardiac sarcoidosis
Authors' conclusion
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.
Study context
- Population
- New users of MTX, mycophenolate or AZA for sarcoidosis, US-based TriNetX electronic health records database, 2008–2023 (601 cardiac, 2840 non-cardiac sarcoidosis; mean age 52.1 years; 55.9% female)601 cardiac sarcoidosis
- Participants
- 3,441 users
- Exposure
- Mycophenolate mofetil or azathioprine vs MTX in sarcoidosis
- Outcome
- MACE among patients with cardiac sarcoidosis
Methodological detailsnew-user design, inverse probability of treatment weighted Cox proportional hazards regression
- New-user design
- Inverse probability of treatment weighted Cox proportional hazards regression
Main finding
As reported in the abstract
Serious cardiac outcomes in cardiac sarcoidosis at baseline
Each group vs methotrexateHazard ratio (95% CI)
Mycophenolate mofetil
0.83(0.43–1.59)
Azathioprine
0.74(0.29–1.89)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Developing cardiac sarcoidosis in non-cardiac sarcoidosis at baselineMycophenolate mofetilvs Methotrexate | 1.11 (0.46–2.66) | |
| Developing cardiac sarcoidosis in non-cardiac sarcoidosis at baselineAzathioprinevs Methotrexate | 0.54 (0.15–1.91) | |
| 0.10.31310Hazard ratio (log scale) |
Developing cardiac sarcoidosis in non-cardiac sarcoidosis at baseline
- Risk of developing cardiac sarcoidosis similar
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| InfectionMycophenolate mofetilvs Methotrexate | 1.83 (1.10–3.05) | |
| InfectionAzathioprinevs Methotrexate | 1.32 (0.92–1.89) | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Comparative effectiveness of disease-modifying antirheumatic drugs for patients with cardiac sarcoidosis. Rheumatology (Oxford). Published 26 December 2024. doi:10.
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