Sarcoidosis is often treated with glucocorticoids, although the use of biologics is growing. Prescribing patterns for biologics for sarcoidosis patients in U.S. rheumatology practices have never been examined. Given that there are no steroid-sparing FDA-approved therapies for sarcoidosis, we sought to characterize the real-world treatment of sarcoidosis and to assess practice-level variation in prescribing patterns.
We conducted an observational study of sarcoidosis patients using data from the Rheumatology Informatics System for Effectiveness (RISE) registry (2014-2018). The RISE registry represents an estimated 32% of the U.S. clinical rheumatology workforce. Adult patients with ≥ 2 codes for sarcoidosis ≥ 30 days apart were included. We examined sarcoidosis-specific medication use at any time during the study period. Data was analyzed at the practice level.
A total of 3276 patients with sarcoidosis from 184 practices were included. 75.1% were women; with mean age 59.0 ± 12.5; 48.3% were White and 27.6% were Black. Overall, 59.3% of patients were prescribed glucocorticoids; 24.7% received prolonged glucocorticoid therapy (≥10 mg/day for 90 days). 12.1% received a biologic or targeted synthetic disease modifying drug (tsDMARD), most commonly TNF inhibitors. There was wide practice-level variation among 31 practices with ≥ 30 sarcoidosis patients: biologic use ranged from 15.6% to 69.2%; infliximab represented the most common biologic prescribed.
In a large sample of U.S. rheumatology practices, 12.1% of patients with sarcoidosis received biologics or tsDMARD. We found high variability in biologic use across practices. The significant use of long-term glucocorticoids suggests unmet therapeutic needs in this patient population.