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Steroids Versus Immunomodulators in Cardiac Sarcoidosis: A Systematic Review
Moiuz Chaudhri1, Brandon Goodwin1, Raviv Markovitz1
1Internal Medicine, Hackensack Meridian Health Ocean University Medical Center, Brick, USA.
Cureus
|April 14, 2025
Summary
This study compared treatments for cardiac sarcoidosis (CS), finding methotrexate most effective for reducing heart inflammation. Corticosteroids remain standard, but methotrexate offers a steroid-sparing option with fewer side effects.
Area of Science:
- Cardiology
- Immunology
- Pharmacology
Background:
- Cardiac sarcoidosis (CS) is a severe condition causing heart failure and arrhythmias.
- Corticosteroids are the standard treatment, but immunomodulators are gaining interest as steroid-sparing options.
Purpose of the Study:
- To systematically review and compare the effectiveness of corticosteroids and immunomodulatory treatments for CS.
- To evaluate treatment impacts on myocardial inflammation (SUVmax) and left ventricular ejection fraction (LVEF).
Main Methods:
- Systematic review and meta-analysis of 11 studies (observational, case series, RCTs) published up to October 2024.
- Evaluation of corticosteroids, methotrexate, infliximab, rituximab, and combinations.
- Analysis of changes in SUVmax and LVEF as primary efficacy endpoints.
Main Results:
- All treatments significantly reduced myocardial inflammation (SUVmax).
- Methotrexate demonstrated the highest effect size for reducing SUVmax (d = 1.65, p < 0.001).
- Infliximab combined with corticosteroids also showed significant SUVmax reduction (d = 1.61, p < 0.001).
- Left ventricular ejection fraction (LVEF) improved modestly across groups; infliximab and corticosteroids showed the most significant LVEF increase (d = 0.4, p = 0.05).
- No statistically significant differences were found between subgroups for SUVmax (p = 0.46) or LVEF (p = 0.36).
Conclusions:
- Corticosteroids are the established first-line therapy for CS.
- Methotrexate shows significant potential as a steroid-sparing agent for reducing myocardial inflammation.
- Infliximab is effective but associated with infection risks; personalized treatment regimens are crucial for CS management.
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