TABLE 3

Summary of included study results: health-related quality of life (HRQoL)

First author [ref.]InterventionEvidence of treatment effectEffect: HRQoLOverall risk of bias
Anti-TNF-α and anti-IL-12 and -23 therapy
 Utz [11]EtanerceptNoNo sign change during follow-up: SF-36 PCS (p=0.17); MCS (p=0.15)
Baseline: PCS 41.8±10.0; MCS 49.0±8.8
High
 Baughman [12,13]InfliximabNo
No
No sign change in SGRQ total score: −4.5±2.1 (placebo); −3.2±2.2 (infliximab 3 mg·kg−1); −4.1±2.1 (infliximab 5 mg·kg−1)
Baseline SGRQ total score: 45.2±18.4 (placebo); 52.1±17.3 (infliximab 3 mg·kg−1); 43.3±19.7 (infliximab 5 mg·kg−1)
No sign change in SF-36 PCS or MCS during follow-up: SF-36 PCS 3.6±8.87 and MCS −0.6±7.42 (combined infliximab); PCS −2.1±6.83 and MCS −3.8±5.62 (placebo)
Baseline PCS 36.5±12.66 (placebo) and 29.7±7.89 (combined infliximab)
Baseline MCS 45.2±7.19 (placebo) and 49.3±13.02 (combined infliximab)
Unclear
 Milman [15]AdalimumabNoImprovement in SF-36 PCS (ns): increase from 34.8 to 38.4 (p=0.07); MCS unchanged with 48.5 versus 48.6 (p=0.28)High
 Pariser [16]AdalimumabYesRCT phase: no sign differences in HRQoL: SHQ at 12 weeks versus baseline: 4.99 versus 4.52 (adalimumab) and 5.00 versus 4.65 (placebo)
Open label phase: improvement in HRQoL: increase SHQ from 4.57 to 5.06 (24 weeks; p=0.0029) to 5.22 (32 weeks; p=0.0015)
RCT phase: low
Open label phase: high
 Judson [17]Ustekinumab GolimumabNoNo sign changes in SGRQ total score at week 28: −9.50±2.790 (placebo); −6.86±2.921 (golimumab; p=0.374); −4.25±2.662 (ustekinumab; p=0.073)
No improvements in treatment arms relative to placebo on SF-36 or SAT
Unclear
 Vorselaars [18]InfliximabYesImprovement on SF-36 physical functioning: baseline SF-36 PF was 40.6 and increased by 8.2 (p=0.009)
Sign improvement in health status: baseline PGA was 61.0 and decreased (improved) by 14.6 (p<0.0001)
High
Corticosteroids and corticotropin
 Aggarwal [19]PrednisoloneYesImprovement in HRQoL: SHQ daily functioning improved from 4.85 (4.00–5.31) to 5.31 (4.62–5.85); p=0.003
SHQ physical functioning improved from 4.67 (4.00–5.17) to 5.33 (4.67–5.67); p=0.007
SHQ emotional functioning improved from 4.80 (3.90–5.50) to 5.30 (4.90–5.90); p=0.001
SHQ total score improved from 4.83 (4.21–5.41) to 5.28 (4.59–5.83); p<0.001
High
 Baughman [20]RCIYesImprovement in KSQ general health status: increase from 49.8 (15.9–70.9) to 54.3 (31.7–100) (week 7 versus baseline; p=0.0043) to 58.1 (23.8–100) (week 24 versus baseline; p=0.0084).
Improvement in KSQ lung score: increase from 42.8 (22.3–61.0) to 54.4 (33.6–100) (week 7 versus baseline; p=0.0067) to 49.6 (37.2–100) (week 24 versus baseline; ns)
No sign change in SGRQ total score: 51.49 (21.89–77.21) to 54.88 (34.1–70.31; week 7) to 54.13 (25.4–71.1; week 24).
No significant differences on other SGRQ scales
High
Other immunosuppressive and/or immunomodulating therapies
 Judson [21]ThalidomideNoNo sign changes in SF-36 domains at week 24 versus baseline: PF 36±4 versus 59±4 (p=0.06); RP 36±6 versus 53±7 (p=0.55); BP 53±5 versus 66±5 (p=0.78); GH 51±4 versus 57±5 (p=0.52); VT 46±3 versus 46±4 (p=0.58); SF 73±5 versus 78±6 (p=0.06); RE 86±6 versus 85±5 (p=0.79); MH 77±3 versus 73±5 (p=0.23); PCS 30±3 versus 39±3; (p=0.94); MCS 56±3 versus 52±4 (p=0.47)High
 Heij [22]ARA 290YesReduction in pain score: SF-36 BP approx. 22 (ARA 290; p<0.01) versus 10 (placebo; ns) and improvement in physical functioning score: SF-36 PF approx. 15 (ARA 290; p<0.01) versus 8 (placebo; ns)
In both arms, increase in general health: SF-36 GH: 35.4±8.3 (ARA 290) and 22.7±7.9 (placebo)
No effects on the remaining SF-36 domains
Low
 Drake [23]CLEAR regimenYesImprovement in HRQoL: SGRQ total score decreased from 51.38±17.96 to 37.19±11.36 (p=0.023); SGRQ symptoms score decreased from 56.55±20.31 to 37.61±11.76 (p=0.078); SGRQ activity score decreased from 66.67±19.72 to 55.26±26.96 (p=0.016); SGRQ impacts score decreased from 40.72±20.72 to 26.65±11.15 (p=0.078)High
Stimulants
 Lower [24]d-MPHYesSGRQ symptoms score was worse during placebo treatment: d-MPH 54 (22–88) versus placebo 61 (34–95) (p<0.05)
No differences on other SGRQ scores
SHQ increased in both arms: 3.4 (2.31–4.68) baseline; 3.9 (2.24–4.91; p<0.01) placebo; 3.8 (2.24–6.48; p<0.02) d-MPH
Low
 Lower [25]ArmodafinilYesImprovement in vitality score, SF-36 VT: increase from 10 (0–55; baseline) to 42 (5–95; p=0.0020; armodafinil) or 25 (0–95; ns; placebo)
No sign effects on SF-36 PCS or MCS
No sign improvement on SHQ: increase from 3.65 (2.56–4.78; baseline) to 4.11 (2.71–5.34; armodafinil) or 3.81 (2.31–5.45; placebo)
Unclear

TNF: tumour necrosis factor; IL: interleukin; ns: nonsignificant; SF-36: Short Form-36 Health Survey Questionnaire; BP: bodily pain; MCS: Mental Component score; SGRQ: St George's Respiratory Questionnaire; PCS: Physical Component score; RCT: randomised controlled trial; SHQ: Sarcoidosis Health Questionnaire; SAT: Sarcoidosis Assessment Tool; PGA: patient global assessment; KSQ: Kings Sarcoidosis Questionnaire; RCI: repository corticotropin; PF: physical functioning; RP: role physical; GH: general health; VT: vitality; SF: social functioning; RE: role emotional; MH: mental health; CLEAR: concomitant levofloxacin, ethambutol, azithromycin, and rifampin; d-MPH: dexmethylphenidate.