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We thank Cohen Aubart et al for their correspondence.1 Their study on 36 patients with sarcoidosis and COVID-19 from 15 French centres provides interesting insights on the outcome of COVID-19 in this group of patients. These data provide evidence that a higher percentage of patients with sarcoidosis with COVID-19 might require intensive care support than in the general population. In contrast, sarcoidosis does not seem to affect the severity of COVID-19, and patients with sarcoidosis-associated interstitial lung disease (ILD) are not admitted more often to the intensive care unit (ICU) than patients without ILD.
The data by Cohen Aubart et al1 show that 85% of the patients with sarcoidosis with COVID-19 admitted to the ICU received a long-term glucocorticoid therapy, in comparison with 61% of the patients who did not require admission to the ICU. The two groups received glucocorticoids in similar doses (median daily dose 7.5 and 8 mg of prednisolone, respectively). Although the numbers are too low for statistical analyses, these data may support a more severe course of COVID-19 in patients treated with glucocorticoids. This conclusion is also supported by other publications on the outcome of COVID-19 in patients with other immune-mediated inflammatory diseases treated with glucocorticoids.2 3 Moreover, our case report provides first evidence that initiation of glucocorticoid treatment might induce relapse of COVID-19.4
The study of Cohen Aubart et al1 also provides insights how the SARS-CoV-2 pandemic affected treatment decisions in rheumatology. Between 1 March and 30 May 2020, physicians decided to continue glucocorticoid therapy, whereas most tumour necrosis factor α (TNF-α) inhibitors were discontinued in patients with sarcoidosis. Recent data show, however, that patients with immune-mediated inflammatory diseases receiving treatment with cytokine inhibitors, in particular TNF-α blockers, have low prevalence of COVID-19 and tend to have a milder course of the SARS-CoV-2 infection.3 5
Taken together, the available data indicate that glucocorticoids may have a negative impact on the outcome of COVID-19, whereas cytokine-targeting therapies such as TNF-α blockers may not. In the context of sarcoidosis, this may argue for a temporary suspension of glucocorticoid therapy, but continuation of TNF-α inhibition.
Handling editor Josef S Smolen
Contributors All authors contributed to drafting and revising the article and approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JHWD is involved in the development of new targeted therapies for fibrotic diseases such as systemic sclerosis. JHWD has consultancy relationships with Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB. JHWD has received research funding from Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX and UCB. JHWD is stock owner of 4D Science and Scientific head of FibroCure.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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