Patient selection: symptomatic cardiac sarcoidosis
Initial dose: 60 to 80 mg of prednisone po per day for 2-3 months.
If the patient has responded to the therapy after the 2-3 months and is tolerating the regimen then:
(1) The dose is gradually tapered over 6 months to 10-15 mg po per day.
(2) The dose may be gradually reduced further if the patient is stable.
(3) Some patients may tolerate discontinuation of the predisone.
If the patient has not responded to the steroid therapy after 2-3 weeks OR if the patient cannot tolerate the adverse effects then:
(1) Select an alternative medication (azathioprine, methotrexate, anti-malarial).
(2) Gradually taper and discontinue the prednisone.
Corticosteroid therapy is more effective if initiated early before significant cardiac damage has occurred. It may not be as effective in advanced diseaes.
Sarcoidosis does not reduce the incidence of ventricular tachycardia. An implantable cardioverter-defibrillator (ICD) may be needed for a patient with refractory ventricular tachyarrhythmias. A patient with severe conduction defects may require a pacemaker.
