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Background  Cardiac sarcoidosis ( CS ) is a noncaseating granulomatous disease of unknown etiology. Lifelong immunosuppressive therapy, most frequently using corticosteroids, is a standard therapy to control hypersensitivity of immune reactions and prevent inflammation. However, it sometimes causes various systemic adverse effects and requires dose escalation. Thus, additional therapy may be required for the treatment of this disease. Recently,  Propionibacterium acnes  ( P. acnes ) was reported as one of the etiologic agents of  CS , indicating that antibacterial drugs ( ABD ) may be effective for the treatment of  CS . The objective of this study was to investigate the effect of  ABD  treatment, in addition to standard corticosteroid therapy, in patients with  CS .    Methods  The Japanese Antibacterial Drug Management for Cardiac Sarcoidosis (J‐ ACNES ) trial was designed as a prospective, multicenter, randomized, open‐label, controlled clinical trial. The patients will be randomized to receive either standard corticosteroid therapy plus  ABD  therapy ( ABD  group) or standard corticosteroid therapy (standard group). The primary endpoint is change in the total standardized uptake value at 6 months vs baseline using fluorine‐18 fluorodeoxyglucose positron emission tomography and computed tomography. Secondary endpoints include efficacy, prognosis, and safety.    Results  The results of this study are currently under investigation.    Conclusion  The J‐ ACNES  trial will be the first prospective study assessing the clinical benefit and safety of  ABD  therapy, in addition to corticosteroid treatment, in patients with  CS . Our findings may improve treatment of patients with  CS , as additional  ABD  therapy reduces recurrence of inflammation and elucidates the mechanism of sarcoidosis.

Japanese Antibacterial Drug Management for Cardiac Sarcoidosis (J‐ ACNES ): A multicenter, open‐label, randomized, controlled study