THU0391 Anti-TNF therapy in severe and refractory sarcoidosis: Multicenter study of 25 patients. (23rd January 2014)

• Record Type: Journal Article
• Authors: Pérez-Martín, I.; Blanco, R.; Ortego, N.; Llorens-Bellés, V.; Adán, A.; Olivé, A.; Sifuentes Giraldo, W.A.; González, S.; Bejerano, C.; González-Vela, M.C.; González-Lόpez, M.A.; Fernández-Llaca, H.; Oterino, A.; Sedano, M.J.; Agudo, M.; Corrales, A.; Martínez-Taboada, V.M.; Gόnzalez-Gay, M.A.
• Is Part Of: Annals of the rheumatic diseases. Volume 71(2012)Supplement 3
• Page Start: 287
• Page End: 288
• Publication Date: 2014-01-23
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2012-eular.2356
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Sarcoidosis is a systemic granulomatous autoimmune disease. Clinically it may range from a mild to a severe life-threatening disease. Objectives: To assess the efficacy of anti-TNFα therapy in refractory and severe sarcoidosis. Methods: We reviewed the medical records of patients seen at several hospitals that were diagnosed as having sarcoidosis and treated with anti-TNFα therapy because of disease severity. Results: We assessed 25 patients (14 women/11 men); mean age at the beginning of anti-TNFα therapy: 47±14 years (range: 27-69); mean duration of sarcoidosis before the onset of anti-TNFα therapy 66±74 months (range 3-360). The main clinical complications that made necessary the use of anti-TNFα agents were: uveitis (9 patients), neurosarcoidosis (6 patients), arthritis (3 patients), skin-lupus pernio (2 patients), lung disease (2 patients), bone marrow involvement-pancitopenia (1 case), systemic-myopathy (1 case), and aortitis (1 case). Most patients had been refractory to oral corticosteroids and at least one immunosuppressive drug. However, in 3 patients with severe neurosarcoidosis anti-TNFα agents were prescribed along with corticosteroids as the initial therapy. In the remaining 22 patients, besides high-dose prednisone, previously to anti-TNFα therapy they had received the following drugs: i.v. methylprednisolone (500-1000 mg for 3 consecutive days) (4 cases), methotrexate (16 cases), azathioprine (3 cases), hydroxychloroquine (2 cases), cyclosporine (1 case), and sulphasalazine (1 cases). Anti-TNFα drugs were usually associated to an immunosuppressive agent (methotrexate, or azathioprine). Infliximab was the most commonly initial anti-TNFα drug used in this series- in 16 cases (3-5 mg/kg/i.v. at 0, 2, 6 and then every 4-8 weeks). Adalimumab was initially administered in the other 8 patients (40 mg/sc EOW or EW if necessary). In 1 patient etanercept (dose 50mg/ew) was initially used, in this case it had to been replaced by infliximab due to inefficacy. Infliximab was discontinued in 5 cases because of inefficacy and in another 2 due to adverse events (severe rash and gastrointestinal intolerance, respectively). In these 5 cases, infliximab was switched to adalimumab. Adalimumab was discontinued in 1 of 8 cases because of development of a lupus-like syndrome. After a mean time of anti-TNFα therapy of 19, 8±19, 8 months (range 1-72), complete clinical remission was achieved in 14 cases and partial improvement in 6 patients. Of major importance, in most patients anti-TNFα treatment allowed the withdrawal or a significant reduction of corticosteroid therapy. The most common adverse events were infections. Three of them were severe: pneumonia by P. jirovecii, septic shock by P. aeruginosa and VV Zoster infection. Conclusions: Infliximab and adalimumab appear to be effective and safe drugs in the management of severe and refractory sarcoidosis. Further controlled studies are warranted. Disclosure of Interest: None Declared