Yvan Jamilloux1, Fleur Cohen-Aubart2, Catherine Chapelon-Abric3, Delphine Maucort-Boulch4, Alicia Marquet5, Laurent Pérard5, Laurence Bouillet6, Alban Deroux6, Sébastien Abad7, Philip Bielefeld8, Diane Bouvry9, Marc André10, Nicolas Noel11, Boris Bienvenu12, Alice Proux13, Sandra Vukusic14, Bahram Bodaghi15, Françoise Sarrot-Reynauld16, Jean Iwaz17, Zahir Amoura2, Christiane Broussolle1, Patrice Cacoub3, David Saadoun3, Dominique Valeyre9, Pascal Sève18. 1. Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande rue de la Croix-Rousse F-69004, Lyon, France; Université Claude Bernard-Lyon 1, Villeurbanne, France. 2. Service de Médecine Interne 2, Institut E3M, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France. 3. Service de Médecine Interne et d׳Immunologie Clinique, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 4. Université Claude Bernard-Lyon 1, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France. 5. Université Claude Bernard-Lyon 1, Villeurbanne, France; Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-Lyon, France. 6. Clinique de médecine interne, pôle pluridisciplinaire de médecine et de gérontologie clinique, Centre Hospitalier Universitaire Grenoble-Alpes, CS10217, Grenoble, France. 7. Service de Médecine Interne, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France. 8. Service de Médecine Interne, Centre Hospitalier Universitaire Le Bocage, Dijon, France. 9. Service de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, Bobigny, France. 10. Service de Médecine Interne, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France. 11. Service de Médecine Interne et d׳Immunologie Clinique, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, UMR 1184, Le Kremlin Bicêtre, France. 12. Service de Médecine Interne, Centre Hospitalier Universitaire de Caen, Caen, France. 13. Service de Médecine Interne, Centre Hospitalier Universitaire de Rouen Rouen, France. 14. Université Claude Bernard-Lyon 1, Villeurbanne, France; Service de Neurologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France. 15. Service d׳Ophtalmologie, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France. 16. Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-Lyon, France. 17. Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France. 18. Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande rue de la Croix-Rousse F-69004, Lyon, France; Université Claude Bernard-Lyon 1, Villeurbanne, France. Electronic address: pascal.seve@chu-lyon.fr.
Abstract
INTRODUCTION: The off-label use of TNF antagonists in refractory sarcoidosis is increasingly reported but data on their efficacy and safety are still insufficient. OBJECTIVE: To report on efficacy and safety of TNF antagonists in severe and refractory sarcoidosis. METHODS: Examination of retrospective demographic, clinical, therapeutic, and adverse event data on 132 sarcoidosis patients (58% women; mean (min-max) age = 45.5 (14-78) years) given TNF antagonists (mainly infliximab, 91%) and investigation of response-linked factors. RESULTS: The overall clinical response (complete and partial) rate was 64%. TNF-antagonist efficacy (i.e., significant decrease of the ePOST score) was noted in cases with neurologic, heart, skin, and upper respiratory tract involvements. No significant difference in efficacy was found between anti-TNF used alone and TNF with immunosuppressant. The use of anti-TNF allowed reducing prednisone dosage at end of follow-up (p < 0.001). Adverse events were observed in 52% of the patients; they included infections (36%) and allergic reactions (8%) and required treatment interruption in 31 cases (23%). When TNF antagonists were interrupted, 13 patients experienced relapses within 14 months on average (median follow-up: 20.5 months). CONCLUSION: TNF antagonists were efficacious in about two-thirds of patients with severe/refractory sarcoidosis but their use led to a high rate of adverse events.
INTRODUCTION: The off-label use of TNF antagonists in refractory sarcoidosis is increasingly reported but data on their efficacy and safety are still insufficient. OBJECTIVE: To report on efficacy and safety of TNF antagonists in severe and refractory sarcoidosis. METHODS: Examination of retrospective demographic, clinical, therapeutic, and adverse event data on 132 sarcoidosispatients (58% women; mean (min-max) age = 45.5 (14-78) years) given TNF antagonists (mainly infliximab, 91%) and investigation of response-linked factors. RESULTS: The overall clinical response (complete and partial) rate was 64%. TNF-antagonist efficacy (i.e., significant decrease of the ePOST score) was noted in cases with neurologic, heart, skin, and upper respiratory tract involvements. No significant difference in efficacy was found between anti-TNF used alone and TNF with immunosuppressant. The use of anti-TNF allowed reducing prednisone dosage at end of follow-up (p < 0.001). Adverse events were observed in 52% of the patients; they included infections (36%) and allergic reactions (8%) and required treatment interruption in 31 cases (23%). When TNF antagonists were interrupted, 13 patients experienced relapses within 14 months on average (median follow-up: 20.5 months). CONCLUSION:TNF antagonists were efficacious in about two-thirds of patients with severe/refractory sarcoidosis but their use led to a high rate of adverse events.
Authors: Matthew C Baker; Khushboo Sheth; Ronald Witteles; Mark C Genovese; Stanford Shoor; Julia F Simard Journal: Semin Arthritis Rheum Date: 2019-11-15 Impact factor: 5.532
Authors: Cesia Gallegos; Evangelos K Oikonomou; Alyssa Grimshaw; Mridu Gulati; Bryan D Young; Edward J Miller Journal: Int J Cardiol Heart Vasc Date: 2021-04-29
Authors: Maria Giovanna Trivieri; Paolo Spagnolo; David Birnie; Peter Liu; Wonder Drake; Jason C Kovacic; Robert Baughman; Zahi A Fayad; Marc A Judson Journal: J Am Coll Cardiol Date: 2020-10-20 Impact factor: 24.094
Authors: Julien Stievenart; Guillaume Le Guenno; Marc Ruivard; Virginie Rieu; Marc André; Vincent Grobost Journal: Front Cardiovasc Med Date: 2021-06-11