Disparate Prednisone Starting Dosages for Systemic Corticosteroid-Naïve Veterans With Active Sarcoidosis

Sarcoidosis is a multiorgan granulomatous disorder of unknown etiology. Clinical manifestations vary and depend, in part, on the extent and severity of organ involvement. Clinical practice guidelines recommend 20 to 40 mg prednisone daily as first-line pharmacotherapy for systemic corticosteroid-naïve patients with active sarcoidosis. This study sought to determine whether initial dosages were guideline adherent.

Records were restrospectively reviewed for patients diagnosed with sarcoidosis who were naïve to systemic corticosteroids and received initial prednisone dosages between 2014 and 2023 at the Jesse Brown Department of Veterans Affairs Medical Center. Patient demographics, medical specialty of the prescriber, and daily starting dosage were tabulated.

Sixty-eight patients were identified; most were Black (n = 52, 76%) and male (n = 62, 91%), with a mean (SD) age of 63 (11) years. Pulmonologists prescribed initial prednisone dosages in the 20 to 40 mg daily range (median, 35 mg). Other specialists, including primary care practitioners, often prescribed 20 mg (median, 17.5 mg; P < .05) initial dosages.

Initial prednisone dosages varied between pulmonologists and nonpulmonologists for systemic corticosteroid-naïve patients with active sarcoidosis. However, this study did not determine reasons for this phenomenon, nor its impact on long-term patient outcomes.