ERS clinical practice guidelines on treatment of sarcoidosis
ERS clinical practice guidelines on treatment of sarcoidosis
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DOI：
10.1183/13993003.04079-2020
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发表时间：
2021-12-01
影响因子：
24.3
通讯作者：
Ouellette, Daniel R.
中科院分区：
文献类型：
--
作者：
Baughman, Robert P.;Valeyre, Dominique;Ouellette, Daniel R.
背景结节病的治疗主要是为了降低发病率和死亡率，提高生活质量。治疗的适应症取决于哪种表现是症状的原因：肺，心脏，大脑，皮肤或其他表现。虽然糖皮质激素仍然是有症状疾病初始治疗的首选，但长期使用与显著毒性相关。糖皮质激素替代品可用。提出的治疗指南旨在为医生治疗非常异质性的结节病表现提供指导。方法由临床医生、方法学家和结节病患者组成的欧洲呼吸学会工作组委员会根据GRADE（建议、评估、发展和评价分级）方法制定了建议。该委员会制定了八个皮科（患者，干预，比较，结果）问题，这些问题用于提出具体的循证建议。工作队委员会为7个PICO提出了12项建议。这些包括治疗肺部、皮肤、心脏和神经系统疾病以及疲劳。一个关于小纤维神经病的皮科问题没有足够的证据支持建议。除了这些建议外，委员会还提供了关于在没有足够证据支持建议时如何使用替代治疗的信息。结论结节病有多种治疗方法。鉴于疾病的多样性，治疗决策需要评估器官受累、显著发病率风险以及疾病和治疗对QoL的影响。
Background The major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin or other manifestations. While glucocorticoids remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. Glucocorticoid-sparing alternatives are available. The presented treatment guidelines aim to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations. Methods A European Respiratory Society Task Force committee composed of clinicians, methodologists and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations. Results The Task Force committee delivered 12 recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac and neurologic disease as well as fatigue. One PICO question regarding small-fibre neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation. Conclusions There are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment.