Management of Hepatic Sarcoidosis: A Retrospective Analysis of Patients at a University Hospital

To explore efficacy of medications, namely steroids, ursodeoxycholic acid (UDC), methotrexate (MTX), azathioprine, mycophenolate mofetil (MMF), and infliximab in the treatment of hepatic sarcoidosis (HS).

We searched for the patients using ICD codes for sarcoidosis (ICD-10: D86) and granulomatous hepatitis (ICD-10: K75.3) at Louisiana State University, Shreveport, and generated 150 unique medical record numbers. We retrospectively reviewed notes, labs, imaging, and medications, and used descriptive statistics to calculate percentages.

47 patients had a diagnosis of HS. 72% of patients had ALP elevation of >200. 36 (76%) patients received steroids, 20 (42%) had MTX, 5 (10%) had azathioprine, 5 (10%) had rituximab, 12 (25%) had infliximab, 3 (6%) had UDC, 21 (44%) had MMF. 12 patients received a combination of prednisone with either MTX, azathioprine, MMF, infliximab, or rituximab. Treatment response was measured based on ALP improvement. 55% of patients responded to prednisone, 45% to MTX, 40% to azathioprine, 60% to rituximab, 66% to infliximab, 47% to MMF, and 30% to UDC.

Majority of the patients presented with ALP elevation of >200. Liver biopsy was performed in only 27% of the patients. Despite being one of the recommended initial therapies, UDC was used in only 3% of patients. Steroids were most commonly used. Among all the steroid-sparing agents, infliximab showed the best efficacy. Similarly, MTX showed improvement, but it was generally avoided due to the risk of hepatotoxicity. Azathioprine, MMF, and rituximab were used either in combination or as sole therapies and have shown improvement in ALP.