Marc A Judson1, Haroon Chaudhry2, Amanda Louis3, Kevin Lee3, Recai Yucel4. 1. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA. Electronic address: judsonm@mail.amc.edu. 2. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA. 3. Department of Medicine, Albany Medical College, Albany, NY, USA. 4. Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, NY 12144, USA.
Abstract
BACKGROUND: Both sarcoidosis and its treatment may worsen health related quality of life (HRQoL). We performed a propensity analysis of sarcoidosis-specific HRQoL patient reported outcome measures (PRO) to disentangle the effects of sarcoidosis and corticosteroid therapy on HRQoL in sarcoidosis outpatients. METHODS: Consecutive outpatient sarcoidosis patients were administered modules from two sarcoidosis-specific HRQoL PROs: the Sarcoidosis Health Questionnaire (SHQ) and the Sarcoidosis Assessment Tool (SAT). Patients were divided into those that received ≤500 mg of prednisone (PRED-LOW) versus >500 mg of prednisone (PRED-HIGH) over the previous year. SAT and SHQ scores were initially compared in the two corticosteroid groups. Then a multivariate analysis was performed using a propensity score analysis adjusted for race, age, gender and the severity of illness. RESULTS: In the unadjusted analysis, the PRED-HIGH group demonstrated the following worse HRQoL scores compared to the LOW-PRED group: SHQ Daily (p = 0.02), SAT satisfaction (p = 0.03), SAT daily activities (p = 0.03). In the propensity analysis, the following domains demonstrated worse HRQoL in the PRED-HIGH group than the PRED-LOW group: SAT fatigue (p < 0.0001), SAT daily activities (p = 0.03), SAT satisfaction (p = 0.03). All these differences exceeded the established minimum important difference for these SAT domains. The SHQ Physical score appeared to demonstrate a borderline improved HRQoL in the PRED-HIGH versus the PRED-LOW group (p = 0.05).). In a post-hoc exploratory analysis, the presence of cardiac sarcoidosis may have explained the quality of life differences between the two corticosteroid groups. CONCLUSIONS: Our cohort of sarcoidosis clinic patients who received ≤500 mg of prednisone in the previous year had an improved HRQoL compared to patients receiving >500 mg on the basis of two sarcoidosis-specific PROs after adjusting for severity of illness. These data support the need to measure HRQoL in sarcoidosis trials, and suggest that the search should continue for effective alternative medications to corticosteroids.
BACKGROUND: Both sarcoidosis and its treatment may worsen health related quality of life (HRQoL). We performed a propensity analysis of sarcoidosis-specific HRQoL patient reported outcome measures (PRO) to disentangle the effects of sarcoidosis and corticosteroid therapy on HRQoL in sarcoidosis outpatients. METHODS: Consecutive outpatientsarcoidosispatients were administered modules from two sarcoidosis-specific HRQoL PROs: the Sarcoidosis Health Questionnaire (SHQ) and the Sarcoidosis Assessment Tool (SAT). Patients were divided into those that received ≤500 mg of prednisone (PRED-LOW) versus >500 mg of prednisone (PRED-HIGH) over the previous year. SAT and SHQ scores were initially compared in the two corticosteroid groups. Then a multivariate analysis was performed using a propensity score analysis adjusted for race, age, gender and the severity of illness. RESULTS: In the unadjusted analysis, the PRED-HIGH group demonstrated the following worse HRQoL scores compared to the LOW-PRED group: SHQ Daily (p = 0.02), SAT satisfaction (p = 0.03), SAT daily activities (p = 0.03). In the propensity analysis, the following domains demonstrated worse HRQoL in the PRED-HIGH group than the PRED-LOW group: SAT fatigue (p < 0.0001), SAT daily activities (p = 0.03), SAT satisfaction (p = 0.03). All these differences exceeded the established minimum important difference for these SAT domains. The SHQ Physical score appeared to demonstrate a borderline improved HRQoL in the PRED-HIGH versus the PRED-LOW group (p = 0.05).). In a post-hoc exploratory analysis, the presence of cardiac sarcoidosis may have explained the quality of life differences between the two corticosteroid groups. CONCLUSIONS: Our cohort of sarcoidosis clinicpatients who received ≤500 mg of prednisone in the previous year had an improved HRQoL compared to patients receiving >500 mg on the basis of two sarcoidosis-specific PROs after adjusting for severity of illness. These data support the need to measure HRQoL in sarcoidosis trials, and suggest that the search should continue for effective alternative medications to corticosteroids.
Authors: R P Baughman; S Nagai; M Balter; U Costabel; M Drent; R du Bois; J C Grutters; M A Judson; I Lambiri; E E Lower; J Muller-Quernheim; A Prasse; G Rizzato; P Rottoli; P Spagnolo; A Teirstein Journal: Sarcoidosis Vasc Diffuse Lung Dis Date: 2011-07 Impact factor: 0.670
Authors: Marc A Judson; Michael Mack; Jennifer L Beaumont; Rosemary Watt; Elliot S Barnathan; David E Victorson Journal: Am J Respir Crit Care Med Date: 2015-04-01 Impact factor: 21.405
Authors: Katherine M Niemeyer; John A Gonzales; Thuy Doan; Erica N Browne; Maya M Rao; Nisha R Acharya Journal: Am J Ophthalmol Date: 2019-06-13 Impact factor: 5.258
Authors: Michelle Sharp; Taylor Brown; Edward S Chen; Cynthia S Rand; David R Moller; Michelle N Eakin Journal: Chest Date: 2020-02-04 Impact factor: 9.410
Authors: David Birnie; Rob S B Beanlands; Pablo Nery; Shawn D Aaron; Daniel A Culver; Robert A DeKemp; Lorne Gula; Andrew Ha; Jeffery S Healey; Yuko Inoue; Mark A Judson; Daniel Juneau; Kengo Kusano; Russell Quinn; Lena Rivard; Mustafa Toma; Amanda Varnava; George Wells; Melissa Wickremasinghe; Jordana Kron Journal: Am Heart J Date: 2019-10-20 Impact factor: 4.749
Authors: Marcia A Friedman; Brian Le; Janelle Stevens; Julianna Desmarais; Daniel Seifer; Kimberly Ogle; Dongseok Choi; Christina A Harrington; Peter Jackson; James T Rosenbaum Journal: Lung Date: 2021-04-07 Impact factor: 2.584