Steroid treatment effect in pulmonary sarcoidosis (STEPS study)

Background: Optimization of first-line prednisone therapy for sarcoidosis is warranted, since side effects can be severe and long-term benefits debated. Prospective data on the early response towards prednisone treatment is lacking. We initiated a prospective study to evaluate the early lung function response to prednisone treatment and tapering, using a calibrated hand-held spirometer at a daily basis. Methods: Treatment naive sarcoidosis patients in whom prednisone therapy is initiated for a pulmonary indication are eligible. Prednisone treatment is protocolled for the first three months (mo). Lung function parameters are shown as mean %predicted(± SD). sIL2 is shown in pg/ml. Results: Up to date, 10 patients are included. Baseline FVC was 68.05(±11.56) and DLCO(csb) 53.41(±16.17). MRC score was 2.71(±0.95), FAS score 29.71(±7.50), and sIL2R was 13196(±10696). Upon treatment, FVC increased to 86.01(±11.08) at 1-mo and 86.37(±9.05) at 3-mo. DLCO increased to 70.23 (±11.08) at 1-mo and 70.90 (±8.43) at 3-mo. MRC score decreased to 1.0(±1.23) at 1-mo and 1.25(±0.96) at 3-mo. FAS score decreased to 20.30(±7.84) at 1-mo and 23.75(±5.19) at 3-mo. sIL2 decreased to 4292(±3444) at 1-mo and 4664(±2552) at 3-mo. Interestingly, already at 10 days(±12.16) the largest proportion(>95%) of FVC increase at 3-mo was reached. Similarly, at day 14 MRC score decreased to 1.6(± 1.34), which was preserved for 3-mo. Conclusion: These results show that in newly-treated sarcoidosis patients the majority of the prednisone effect is reached within 2 weeks. Daily monitoring of the pulmonary function can help individualize first-line prednisone therapy in pulmonary sarcoidosis patients, aiming at early dose tapering and reducing side-effects.