P217 Experience with tumour necrosis factor-alpha inhibitors for the treatment of cardiac sarcoidosis in a U.K. medical centre. (11th November 2022)

• Record Type: Journal Article
• Authors: Ahmed, R; Okafor, J; Shi, R; Azzu, A; Wechalekar, K; Baksi, J; Pennell, D; Collins, P; Wells, A; Khattar, R; Sharma, R; Kouranos, V
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A197
• Page End: A199
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.349
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction and Objectives: Cardiac sarcoidosis (CS) is associated with significant morbidity and mortality. First and second line management is usually with steroids and immunosuppressive medications. In the United Kingdom, tumour necrosis factor alpha inhibitors, including infliximab, are currently not licensed for treatment of cardiac sarcoidosis because of apprehension around worsening heart failure. Nonetheless, they have been used as salvage therapies in patients with refractory cardiac sarcoidosis. Methods: We conducted an observational study of all cardiac sarcoidosis patients treated with infliximab in a tertiary centre, with specialist cardiac sarcoidosis service, from January 2017 to April 2022. Results: Out of 1348 CS patients in our registry, five male patients diagnosed with pulmonary and cardiac sarcoidosis were treated with infliximab(3–5 mg/kg) due to refractory cardiac disease despite conventional treatment. One of the patients had a relapse (ventricular arrhythmia and FDG-uptake) seven months after stopping infliximab and was subsequently restarted on infliximab. The mean(±SD) age at CS diagnosis was 45.8(±4.4) years and mean duration between CS diagnosis and starting infliximab was 26.42 (±14.77) months. Infliximab was commenced due to persistent inflammation on FDG-PET scan despite being on at least two agents (prednisolone and methotrexate ± hydroxychloroquine) in 4 cases and prednisolone alone (intolerance to methotrexate) in one case. At baseline, 4 patients presented with ventricular arrhythmias and 2 with heart failure. After a mean (±SD) follow up of 15.2(±6.8) months, 83.3% (n=5) of the patients had decreased myocardial uptake on PET (1 was awaiting a scan), mean left ventricular (LV) ejection fraction (n=4) improved from 51% (±5.61) to 59.5% (±5.5) and mean (±SD) prednisolone dose decreased from 18.33 mg (±6.87) to 13.33 mg (±3.73). One patient died following complications of patent foramen ovale repair. There were no new ventricular arrhythmias, aborted sudden cardiac death episodes or need for a cardiac transplant. There were two new cases of infection (pneumonia and COVID-19 pneumonitis) during follow-up. Conclusions: Infliximab can play a vital role in stabilising refractory cardiac sarcoidosis by stemming clinical deterioration, arrhythmia burden and decreasing the dose of maintenance steroids used. However, there is a risk of infections and possible relapse on ceasing infliximab.