Key result
Discontinuing MTX in cardiac sarcoidosis responders maintains durable remission in ~92% of patients.
Why the study?
Cardiac sarcoidosis treatment is challenging with limited data on optimal therapies and treatment duration, prompting an investigation into relapse rates after discontinuation of methotrexate.
Does discontinuation of methotrexate lead to durable remission in patients with cardiac sarcoidosis who previously responded to treatment?
Cohort (n=12)
No
Does discontinuation of methotrexate lead to durable remission in patients with cardiac sarcoidosis who previously responded to treatment?
Discontinuation of methotrexate in stable cardiac sarcoidosis patients may yield durable cardiac remission in over 90% of cases, though careful monitoring is required due to the risk of severe relapse.
May support methotrexate discontinuation in cardiac sarcoidosis responders; hypothesis-generating and requires randomized confirmation.
INTRODUCTION: Cardiac sarcoidosis (CS) treatment is challenging due to limited data. Key unknowns include optimal therapies and treatment duration. Data from pulmonary sarcoidosis suggest three disease phenotypes: acute (<1-2 years), chronic, and advanced. Our previous research showed that after a one-year course of corticosteroids, 1/3 of patients did not relapse (acute treatment phenotype), while 2/3 did. This study aims to investigate relapse rates in patients after discontinuation of Methotrexate (MTX). METHODS: This is a single-centre sub-study of the Cardiac Sarcoidosis Multi-Center Prospective Cohort Study (CHASM-CS; NCT01477359). A follow-up PET scan 6-12 months was performed post-MTX discontinuation to assess for relapse. Patients without cardiac relapse were followed clinically thereafter with annual ECGs and echocardiograms. RESULTS: Twelve consecutive MTX responders (mean age: 53.6 ± 8.2 years, 66.6 % female) were included. Mean MTX treatment duration was 44.6 ± 17.6 months. One patient (8.3 %) had recurrent cardiac and extracardiac sarcoidosis, presenting with ventricular tachycardia storm 6.1 months after stopping MTX. Four patients (33.3 %) had recurrent extracardiac sarcoidosis only. Eleven non-cardiac relapsers were followed for an average of 24.9 ± 12.3 months with no adverse clinical events or late relapses. CONCLUSIONS: In 11/12 (91.7 %) patients, CS remained in remission after discontinuation of MTX. These results need replication in larger populations.
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Alipour et al. (2025) conducted a cohort in Cardiac sarcoidosis (n=12). Methotrexate discontinuation was evaluated on Cardiac relapse. Discontinuation of methotrexate in cardiac sarcoidosis responders resulted in durable remission in 91.7% of patients, with only 8.3% experiencing cardiac relapse.
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