Prevalence and Risk Factors for Relapse in Pulmonary Sarcoidosis: The First Systematic Review, Meta-analysis, and Future Directions
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Background and Aim
Relapses are known to adversely affect the prognosis of patients with pulmonary sarcoidosis (PS). However, a systematic review or meta-analysis on the subject is not yet available in the literature.
Research question
What are the global prevalence and underlying risk factors for relapse in PS patients?
Methods
We systematically searched PubMed, Google Scholar, Scopus, and Embase for eligible PS studies published until 31 January 2025. Eligible studies were peer-reviewed, English-language articles reporting relapse and risk factors in PS patients. Prevalence and risk factors were analysed via proportions and log odds ratios (LORs) with 95% confidence intervals (CIs). Quality was assessed via the Hoy et al. tool for prevalence studies.
Results
Fifty studies with 5978 patients were included; 3646 patients were followed up for relapse analysis. Heterogeneity was significant (I²=94%). The pooled relapse incidence was 0.40 (95% CI: 0.34–0.46). The estimates were robust in the sensitivity analyses (0.35--0.41). The prevalence was lower in prospective studies (0.32, 95% CI: 0.26--0.38) than in retrospective studies (0.44, 95% CI: 0.36--0.54; meta-regression p=0.02). Relapse risk was greater in black patients (LOR 0.91, 95% CI: 0.44–1.37; p<0.001), those with stage II–III disease (0.55, 95% CI: 0.07–1.03; p=0.02), and those with stage IV disease (1.04, 95% CI: 0.25–1.83; p=0.01) but was comparable for age, sex, treatment type, and PS type (isolated or systemic).
Conclusion
The pooled prevalence of PS relapse was 40%, but it was lower in prospective studies. A black race and higher-grade radiographic stages were the underlying risk factors for disease relapse.
Take-Home Message
Research Question
What is the global occurrence and etiology of relapse among patients with pulmonary sarcoidosis illness?
Relapse is a significant problem, with an overall pooled prevalence of 40%. The risk factors are advanced disease and black race. The prevalence of relapse was lower in prospective studies. Future prospective studies with proper relapse definitions are needed.
