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Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review
BACKGROUND: Corticosteroid therapy for the treatment of clinically manifest cardiac sarcoidosis is generally recommended. Our group previously systematically reviewed the data in 2013; since then, there has been increasing quality and quantity of data and also interest in nonsteroid agents. METHODS...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649244/ https://www.ncbi.nlm.nih.gov/pubmed/34472360 http://dx.doi.org/10.1161/JAHA.121.021183 |
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author | Fazelpour, Siavosh Sadek, Mouhannad M. Nery, Pablo B. Beanlands, Rob S. Tzemos, Niko Toma, Mustafa Birnie, David H. |
author_facet | Fazelpour, Siavosh Sadek, Mouhannad M. Nery, Pablo B. Beanlands, Rob S. Tzemos, Niko Toma, Mustafa Birnie, David H. |
author_sort | Fazelpour, Siavosh |
collection | PubMed |
description | BACKGROUND: Corticosteroid therapy for the treatment of clinically manifest cardiac sarcoidosis is generally recommended. Our group previously systematically reviewed the data in 2013; since then, there has been increasing quality and quantity of data and also interest in nonsteroid agents. METHODS AND RESULTS: Studies were identified from MEDLINE, EMBASE, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and the National Institutes of Health ClinicalTrials.gov database. The quality of included articles was rated using Scottish Intercollegiate Guidelines Network 50. Outcomes examined were atrioventricular conduction, left ventricular function, ventricular arrhythmias, and mortality. A total of 3527 references were retrieved, and 34 publications met the inclusion criteria. There were no randomized trials, and only 2 studies were rated good quality. In the 34 reports (total of 1297 patients), 1125 patients received corticosteroids, 235 received additional or other immunosuppressant therapy, and 97 patients received no therapy. There were 178 patients treated for atrioventricular conduction disease, with 76/178 (42.7%) improving. In contrast, 21 patients were not treated with corticosteroids and/or immunosuppressant therapy, and none of them improved. Therapy was associated with the prevention of deterioration in left ventricular function. A total of 8 publications reported on ventricular arrhythmia burden, and 19 reported on mortality; the data quality was too limited to draw conclusions for the latter 2 outcomes. CONCLUSIONS: The best quality data relate to atrioventricular nodal conduction and left ventricular function recovery. In both situations, therapy with corticosteroids and/or immunosuppressant therapy were sometimes associated with positive outcomes. The data quality is too limited to draw conclusions for ventricular arrhythmias and mortality. |
format | Online Article Text |
id | pubmed-8649244 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-86492442022-01-14 Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review Fazelpour, Siavosh Sadek, Mouhannad M. Nery, Pablo B. Beanlands, Rob S. Tzemos, Niko Toma, Mustafa Birnie, David H. J Am Heart Assoc Systematic Review and Meta‐analysis BACKGROUND: Corticosteroid therapy for the treatment of clinically manifest cardiac sarcoidosis is generally recommended. Our group previously systematically reviewed the data in 2013; since then, there has been increasing quality and quantity of data and also interest in nonsteroid agents. METHODS AND RESULTS: Studies were identified from MEDLINE, EMBASE, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and the National Institutes of Health ClinicalTrials.gov database. The quality of included articles was rated using Scottish Intercollegiate Guidelines Network 50. Outcomes examined were atrioventricular conduction, left ventricular function, ventricular arrhythmias, and mortality. A total of 3527 references were retrieved, and 34 publications met the inclusion criteria. There were no randomized trials, and only 2 studies were rated good quality. In the 34 reports (total of 1297 patients), 1125 patients received corticosteroids, 235 received additional or other immunosuppressant therapy, and 97 patients received no therapy. There were 178 patients treated for atrioventricular conduction disease, with 76/178 (42.7%) improving. In contrast, 21 patients were not treated with corticosteroids and/or immunosuppressant therapy, and none of them improved. Therapy was associated with the prevention of deterioration in left ventricular function. A total of 8 publications reported on ventricular arrhythmia burden, and 19 reported on mortality; the data quality was too limited to draw conclusions for the latter 2 outcomes. CONCLUSIONS: The best quality data relate to atrioventricular nodal conduction and left ventricular function recovery. In both situations, therapy with corticosteroids and/or immunosuppressant therapy were sometimes associated with positive outcomes. The data quality is too limited to draw conclusions for ventricular arrhythmias and mortality. John Wiley and Sons Inc. 2021-09-02 /pmc/articles/PMC8649244/ /pubmed/34472360 http://dx.doi.org/10.1161/JAHA.121.021183 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Systematic Review and Meta‐analysis Fazelpour, Siavosh Sadek, Mouhannad M. Nery, Pablo B. Beanlands, Rob S. Tzemos, Niko Toma, Mustafa Birnie, David H. Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review |
title | Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review |
title_full | Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review |
title_fullStr | Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review |
title_full_unstemmed | Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review |
title_short | Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review |
title_sort | corticosteroid and immunosuppressant therapy for cardiac sarcoidosis: a systematic review |
topic | Systematic Review and Meta‐analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649244/ https://www.ncbi.nlm.nih.gov/pubmed/34472360 http://dx.doi.org/10.1161/JAHA.121.021183 |
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