Outcomes in Pulmonary Sarcoidosis: Results of a Newly Implemented Prednisone Protocol.

Abstract Background Prednisone is used as first-line therapy for patients with pulmonary sarcoidosis. There is however no clear association between prednisone dose and FVC change in patients with pulmonary sarcoidosis. In order to improve our standard of care we introduced a more conservative prednisone protocol. Methods This study is a single centre observational non-inferiority study. In the new protocol, prednisone intake was reduced from a starting dose of 40 mg to a starting dose of 20 mg and was introduced on the 1st of September 2017. Primary outcomes evaluated were FVC % predicted, FEV1 % predicted and DLCO % predicted. The secondary outcome measure was BMI. Results 369 patients were included in the old-cohort (Sept. 2015 – Sept. 2017) and 215 in the new-cohort (Oct. 2017 – Sept. 2019). In the old-cohort, 182 (49.0%) of the patients were treated with prednisone. In total, 114 patients (62.6%) were treated according to the old protocol with a mean initial prednisone dose of 32.1 ± 14.2 mg. In the new-cohort, 93 patients (45.0%) were treated with prednisone of which 53 patients (57.0%) received prednisone according to the new protocol. The mean initial prednisone dose in the new-cohort was 21.4 ± 9.8 mg. Changes in FVC and FEV1 % predicted did not vary. Change in % predicted DLCO was 2.4 ± 9.3 for the old-cohort and − 1.3 ± 11.4 for the new-cohort (p = 0.01). No statistically significant changes in BMI were observed. Conclusions Our results indicate that in more than half of the patients the new protocol was followed. The new protocol with reduced prednisone intake seems non-inferior compared to the old prednisone protocol looking at the changes in pulmonary function and BMI. We have shown that applying VBHC principles in a sarcoidosis centre can promote the delivery of high-value clinical care.