# Cardiale sarcoïdose: een onderhoudsdosis corticosteroïden van 5-10 mg/dag geeft de beste prognose

*geplaatst 2026-03-06 · Algemeen · Open Heart · doi http://openheart.bmj.com/cgi/content/short/13/1/e004048?rss=1 · https://hartvaat.nl/2026/03/06/cardiale-sarcoidose-een-onderhoudsdosis-corticosteroiden-van-5-10-mg-dag-geeft-d/*

Japanse richtlijnen adviseren bij cardiale sarcoïdose (CS) een corticosteroïd-onderhoudsdosis van 5-10 mg/dag, maar de optimale dosis was onduidelijk. In dit multicentrische retrospectieve cohort uit een Japans nationaal CS-register (352 patiënten op orale corticosteroïden) werden patiënten ingedeeld naar onderhoudsdosis: laag (<5 mg/dag), aanbevolen (5-10 mg/dag) en hoog (>10 mg/dag). Over een mediane follow-up van 5,1 jaar overleed 11%. De aanbevolen dosis gaf de beste overleving; de hoge dosis deed het significant slechter (sterfte 8% bij de aanbevolen dosis vs. 25% bij de lage en 17% bij de hoge). Bij 19% was een herverhoging van de dosis nodig, wat in de hoge- en lage-dosisgroep met sterfte samenhing. Het bereiken en aanhouden van de aanbevolen onderhoudsdosis van 5-10 mg/dag is dus van groot belang voor de prognose bij cardiale sarcoïdose.

## English: Prognostic impact of corticosteroid maintenance dose and re-escalation in patients with cardiac sarcoidosis

Japanese guidelines recommend a corticosteroid maintenance dose of 5-10 mg/day for cardiac sarcoidosis (CS), but the optimal dose was unclear. In this multicentre retrospective cohort from a Japanese national CS registry (352 patients on oral corticosteroids), patients were grouped by maintenance dose: low (<5 mg/day), recommended (5-10 mg/day) and high (>10 mg/day). Over a median 5.1-year follow-up, 11% died. The recommended dose gave the best survival; the high dose did significantly worse (mortality 8% with the recommended dose vs 25% low and 17% high). Dose re-escalation was needed in 19%, associated with mortality in the high- and low-dose groups. Achieving and maintaining the recommended 5-10 mg/day maintenance dose is thus important for prognosis in cardiac sarcoidosis.

## Abstract (original, from the publication)

<sec><st>Background</st>
<p>Japanese guidelines recommend a corticosteroid maintenance dose of 5&ndash;10 mg/day for cardiac sarcoidosis (CS); however, the optimal dose remains unclear. This study aimed to evaluate the impact of maintenance dose and corticosteroid re-escalation on prognosis in patients with CS.</p>
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<sec><st>Methods</st>
<p>This multicentre retrospective cohort study used data from a Japanese nationwide CS registry. A total of 352 patients diagnosed according to the Japanese Circulation Society 2016 guideline and treated with oral corticosteroids were included. Patients were grouped by maintenance dose: low (&lt;5.0 mg/day), recommended (5.0&ndash;10.0 mg/day) and high (&gt;10.0 mg/day). Clinical outcomes were analysed. The main outcome was all-cause mortality.</p>
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<sec><st>Results</st>
<p>The low-dose, recommended-dose and high-dose groups comprised 11% (n=40), 78% (n=276) and 10% (n=36) of patients, with mean maintenance doses of 2.2 mg/day, 6.7 mg/day and 16.2 mg/day, respectively. During a median follow-up of 5.12 years, 39 patients (11%) died. Kaplan-Meier survival analysis showed statistically better survival in the recommended dose group, with the high-dose group showing statistically significantly worse outcomes (log-rank p=0.012). Corticosteroid re-escalation occurred in 19% of patients (9% before and 11% after achieving maintenance dose). All-cause mortality was 8% in the recommended-dose group versus 25% in the low-dose and 17% in the high-dose groups. In univariable analyses, re-escalation after achieving maintenance was associated with mortality in the high-dose group (HR 4.34, 95% CI 1.24 to 98.3), whereas re-escalation before achieving maintenance was associated with mortality in the low-dose group (HR 19.41, 95% CI 2.71 to 138.5).</p>
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<sec><st>Conclusions</st>
<p>A recommended maintenance dose of corticosteroids was associated with better prognosis in patients with CS. Achieving and maintaining this dose appears critically important in clinical management.</p>
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Auteurs: Nishimura, T., Ishibashi, K., Kanaoka, K., Nakajima, K., Ikee, T., Syako, D., Nakamura, T., Oka, S., Wakamiya, A., Ueda, N., Kamakura, T., Wada, M., Inoue, Y., Miyamoto, K., Aiba, T., Kusano, K.

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Bron: Open Heart, https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e004048?rss=1. Bijgewerkt 2026-07-03T13:31:20Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.