Pulmonary dysfunction phenotypes in patients with sarcoidosis vary by race and gender

Important points:

• The restrictive phenotype typically associated with sarcoidosis was seen in only 47% of patients with abnormal lung function.
• Black and white patients had different phenotypic prevalence.

Sarcoidosis patients of different races and genders had different frequencies of pulmonary dysfunction phenotypes, according to the results of a study published in . Chronicles of the American Thoracic Society.

Michelle Whitfield sharp

“Significant health disparities exist in sarcoidosis.” Michelle Whitfield Sharp, MD, MHS, Co-director of the sarcoidosis program at Johns Hopkins University and assistant professor of medicine told Healio. We also found significant differences in functional severity, with blacks having significantly worse lung function than whites.More work is needed to address the health disparities in sarcoidosis.”

In a retrospective cohort study, Sharp and colleagues analyzed 602 patients (median age, 51 years, 64% female, 57% black). sarcoidosis We describe the occurrence of different lung function phenotypes from tertiary referral centers between 2005 and 2015 and determine whether phenotypes differ significantly by race or gender.

Researchers evaluated pulmonary function test (PFT) data such as FEV.₁the lung FVC and diffusing capacity for carbon monoxide (DL_CO), and demographic data.

To account for the different phenotypes of sarcoidosis patients, researchers classified them into four categories based on pulmonary dysfunction: limited (FVC < lower limit of normal [LLN] and FEV₁/FVC LLN), Obstacles (FEV₁/FVC < LLN), combined limits and impairments (FVC < LLN and FEV₁/FVC < LLN) and lone gas transfer defects (DL_CO < LLN, no restrictive or obstructive defects). In addition, FEV was calculated using the formula from the Global Lung Function Initiative.₁FVC and DL_CO percent forecast.

In addition, researchers performed chi-square analysis and multiple linear regression to assess how phenotypes differed by race, sex, disease duration, and tobacco use.

Phenotypic prevalence

Researchers found 562 (93%) patients had lung involvement, 56% of whom had abnormal lung function.

All defined phenotypes of pulmonary dysfunction were found in the cohort, but in variable proportions. The most common phenotypes were restriction (47%) followed by obstruction (22%), combined restriction and obstruction (16%), and decreased DL alone._CO (15%).

“It’s important to know that sarcoidosis is not just a restrictive lung disease,” Sharpe told Healio. “Clinicians should be aware of the different pulmonary function phenotypes in sarcoidosis and consider evaluating patients with pulmonary sarcoidosis beyond pulmonary spirometry.”

Regarding the prevalence of phenotypes by race, the researchers found that in 66% the majority of white patients did not show lung damage, whereas this was seen in only 26% of black patients. Patients had the highest prevalence of the restrictive phenotype (41%), but not Caucasian patients (9%).

Furthermore, white patients had more obstructive phenotypes than black patients (17% vs. 9%).

Gender also showed differences in phenotypic frequencies. For example, the obstructive phenotype occurred in more males than females (19% vs. 9%; P. = .001). Furthermore, the restrictive phenotype was more common in females than in males (30% vs 21%; P. = .031).

Researchers also found phenotypic differences between disease duration and smoking.Comparison with restrained/occluded/isolated DL_CO Patients with combined phenotypes, restrictive and obstructive phenotypes, had the greatest disease duration (median, 10 years; P. = .037) and DL alone decreased alongside_COthe number of current smokers increased.

Lung function measures

When evaluating percent predictive measures of lung function, researchers observed lower lung function in black patients than in white patients and in women than in men.

For black patients, this result persisted for all phenotypes but none combined. In women, this result was observed in the restrictive and obstructive phenotypes, whereas decreased lung function was observed in men in the combined phenotype, according to the researchers.

After adjusting for gender, tobacco use, disease duration, and organ involvement in the regression model, the researchers further found that in the predicted FVC percent (–16.39; 95% CI, –19.49 to –13.29), black patients had We found that lung function was lower than in Caucasian patients. FEV₁ Percent predicted (–13.41; 95% CI, –16.77 to –10.04) and DL_CO % predicted (–16.2; 95% CI, –19.8 to –12.6).

Females had greater DL in this adjusted model_CO percent predicted (4.45; 95% CI, 0.89–8; P. = .014) than men.

“Clinical trials and prospective studies of pulmonary sarcoidosis should keep the pulmonary function phenotype in mind,” Sharp told Healio. raises the question of whether it is appropriate to use percent predicted FVC as the sole primary outcome measure of lung function.”

This study by Sharp and colleagues adds important findings related to sarcoidosis and its various phenotypes. Specifically, the restrictive phenotype that researchers wrote historically associated with sarcoidosis occurred only in 47% of patients with abnormal lung function. We are calling for a re-evaluation of the instruments used in the study. please N.no band, MD, MPH, MSc, Assistant Professor, East Carolina University School of Medicine.

“While FVC is certainly an important clinical endpoint that should be included in clinical trials, Sharp and colleagues’ findings reinforce that it is not representative of all (or most) patients with pulmonary sarcoidosis. (irrespective of the radiographic pattern).It is the sole criterion or focal point that determines the success or failure of an intervention,” wrote Obi. “Indeed, these data suggest that he continues to focus on FVC as the sole or most important primary endpoint in the clinical trials he evaluates. Treatment of pulmonary sarcoidosis Potentially effective drugs/interventions may be misclassified as ineffective for the majority of patients in whom an overt change in FVC may not be realizable due to their disease phenotype. ”

For more information:

Michelle Sharp, MD, MHS, can be reached by [email protected].

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