PhD defence V. (Vivienne) Kahlmann

Below is a brief summary of the dissertation:

This thesis focuses on optimizing treatment and outcomes for patients with sarcoidosis. Sarcoidosis is a systemic inflammatory disease that can affect any organ, most commonly the lungs. The clinical course and prognosis are highly variable, ranging from spontaneous remission to chronic organ involvement.

Currently, prednisone is the standard first-line treatment but is frequently associated with numerous side effects. Methotrexate, commonly used as second-line therapy, appears better tolerated; however, it has not been directly compared with prednisone.
The PREDMETH trial, a randomized controlled non-inferiority study, evaluated the efficacy of methotrexate compared to prednisone as first-line therapy for pulmonary sarcoidosis in 138 patients. Results demonstrated that methotrexate is non-inferior to prednisone in improving lung function. The total number of side effects was similar; however, fewer side effects persisted in the methotrexate group at 24 weeks. The side effect profiles differed: for prednisone, the most commonly reported were weight gain and insomnia, while for methotrexate and nausea. These findings indicate that methotrexate is a well-tolerated alternative and highlight the importance of shared decision-making when choosing the optimal treatment for an individual patient.

In addition to organ-related manifestations, patients may experience fatigue and psychological complaints, which can significantly impact daily life. These non-organ-related symptoms are often overlooked but highly burdensome.
The TIRED trial, a randomized controlled study, assessed a 12-week supervised online mindfulness-based cognitive therapy (eMBCT) program for patients with stable sarcoidosis experiencing fatigue. Patients receiving eMBCT showed meaningful reductions in fatigue, along with improvements in anxiety, depressive symptoms, mindfulness, and overall health.

Overall, this thesis contributes to advancing both pharmacological and non-pharmacological treatment for sarcoidosis, as well as enhancing patient-centered care.