Background and aim
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 study, applying value-based healthcare (VBHC) and quality improvement (QI) principles.
Prednisone intake was reduced from a starting dose of 40 mg to a starting dose of 20 mg. Primary outcomes evaluated were FVC, FEV1 and DLCO % predicted. The secondary outcome measure was BMI. Results 369 patients were included in the old-cohort and 215 in the new-cohort. 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. Data support the observation that a more conservative
prednisone regimen might be equally effective, looking at changes in pulmonary function and BMI.