Targeting the TNF-alpha pathway in sarcoidosis.

UNLABELLED: IMPORTANCE OF THE FIELD/SIGNIFICANCE: Sarcoidosis is a granulomatous disease with various organ manifestations in which TNF-alpha has been demonstrated to play a major pathogenic role. The existing conventional therapies are not always able to minimize TNF-alpha-driven inflammation and other approaches should be used. AREAS COVERED IN THIS REVIEW: TNF-alpha roles in sarcoid inflammation and granuloma formation are reviewed based on the literature published in the last two decades and the therapies able to target it specifically or non-specifically in sarcoidosis are discussed. WHAT THE READER WILL GAIN: A better understanding of the pathogenic role of TNF-alpha in sarcoidosis and of the scientific rationale of its therapeutic blockade. TAKE HOME MESSAGE: In some subsets of sarcoidosis with more rapid progession and/or therapeutic refractoriness TNF-alpha plays a more prominent role in disease pathogenesis, and its blockade might represent an appropriate therapeutic approach.