Systematic review finds high relapse rates in pulmonary sarcoidosis across diverse study designs.

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medRxiv Published April 18, 2026 Medically reviewed April 25, 2026 Study authors: Hashim, Z.; Baughman, R. P.; Agarwal, R.; Tripathy, N. K.; Nath, A.; Gupta, M.; Khan, A.; Kumar, A.;… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note substantial heterogeneity in relapse rates; interpret pooled estimates cautiously.

This systematic review and meta-analysis examined the prevalence of relapse among patients diagnosed with pulmonary sarcoidosis. The analysis included a large number of patients who were followed up over varying periods to determine the frequency of disease recurrence. The primary outcome assessed was the overall rate of relapse, while secondary outcomes explored potential risk factors and differences based on study design. The authors observed that the pooled prevalence of relapse was considerable, with prospective studies showing lower rates compared to retrospective ones. Additionally, specific patient subgroups, including those with advanced disease stages and certain demographic backgrounds, demonstrated a higher likelihood of relapse compared to others.

The authors noted that significant heterogeneity existed among the included studies, as indicated by statistical tests for variance. This variability suggests that the definition of relapse or the methodology used to track patients may differ substantially between investigations. Consequently, the pooled estimates should be viewed as general indicators rather than precise predictions for individual patients. The review did not report specific safety data or adverse events, limiting the ability to assess tolerability or side effects associated with the disease course or management strategies discussed.

Despite the large sample size, the significant heterogeneity and lack of standardized outcome definitions constrain the direct clinical application of these findings. The authors caution against overinterpreting the specific percentages without considering the context of the individual studies contributing to the meta-analysis. Clinicians should recognize these findings as a baseline for understanding disease behavior but must tailor expectations to the specific clinical scenario and available patient data.

Study Details

Study typeMeta analysis

Sample sizen = 5,978

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

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 risk factors for relapse in PS patients? Methods: We systematically searched PubMed, Google Scholar, Scopus, and Embase electronic databases to collect eligible PS studies published until 31 January 2025. Eligible studies were peer-reviewed, English-language studies reporting relapse and risk factors in PS patients. Prevalence and risk factors were analyzed using proportions and log odds ratios (LORs) with 95% confidence intervals (CIs). Quality was assessed by Hoy et al tool for prevalence studies Results: A total of 50 studies with 5978 patients were included in this meta-analysis. Among these patients, 3646 were followed up, and PS relapse was analyzed. Relapse prevalence heterogeneity was significant (Q test, p<0.01). The pooled prevalence of relapse was 0.40 (95% CI: 0.34, 0.46) in all included studies. Sensitivity analyses of the pooled prevalence estimate showed minimal variation, with estimates ranging from 35% to 41% across analyses removing outliers, performing leave-one-out, adjusting for study size, excluding lower-quality studies, and excluding studies without relapse definitions. The pooled prevalence of relapse in prospective vs. retrospective studies was 0.32 (95% CI: 0.26, 0.38) vs. 0.44 (95% CI: 0.36, 0.54), with a meta-regression coefficient of 0.14 (p = 0.02). The pooled LOR of relapse was greater for patients who were black [0.91 (95% CI: 0.44, 1.37); p<0.001], had stage II & III disease [0.55 (95% CI: 0.07, 1.03); p=0.02], and had stage IV disease [1.04 (95% CI: 0.25, 1.83); p=0.01], whereas it was comparable for age, sex, treatment type, and PS type (isolated or systemic PS). Conclusion: The pooled prevalence of PS relapse in all studies 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. KEYWORDS: Pulmonary Sarcoidosis, Relapse, Risk Factors, Meta-analysis

Systematic review finds high relapse rates in pulmonary sarcoidosis across diverse study designs.

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