Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Anti-TNF Therapy in 15 Patients with Severe and Refractory Sarcoidosis.

Perez-Martin1,  Inés, Blanco2,  Ricardo, Rueda1,  Javier, Bejerano2,  Carmen, Pompei1,  Orlando, Gonzalez-Vela1,  M. Carmen, Gonzalez-Lopez1,  Marcos A.

Hospital Universitario Marqués de Valdecilla. IFIMAV, Santander, Spain
Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain

Background/Purpose:

Sarcoidosis is a systemic granulomatous autoimmune disease. Clinically it may range from a mild to a severe life-threatening disease.

Methods:

We reviewed the medical records of patients seen at the Rheumatology Service of a University hospital that were diagnosed with sarcoidosis and treated with anti-TNFa therapy because of disease severity.

Results:

We assessed 15 patients (8 women/7 men); mean age at disease diagnosis: 49±15 years (range: 28–69); mean duration of sarcoidosis before the onset of anti-TNFa therapy 74±95 months (range 12–360) (TABLE).

patientage/sexmain clinical complicationimmunosuppressive agents prior to anti-TNFaprednisone dose at anti-TNFa onset1st anti-TNFa/2nd anti-TNFaimmunosuppressive drug with anti-TNFa
164/Flupus pernioHQ/AZA/MTXinfliximabMTX
246/Mgeneral syndrome and myopathyHQ/MTX40 mg/dinfliximabMTX
348/FuveítisMTX45 mg/dinfliximabMTX
433/FuveítisSZP/MTX30 mg/dinfliximab/adalimumabMTX
528/MuveítisAZA40 mg/dadalimumabAZA
630/MuveítisHQ/MTX30 mg/dinfliximabAZA
769/Mbone marrow-pancytopeniaMTX30 mg/dinfliximab/adalimumabMTX
867/FneurosarcoidosisMTX40 mg/dinfliximabMTX
965/FneurosarcoidosisMTX40 mg/dinfliximab/adalimumabMTX
1054/MuveitisCyA45 mg/dadalimumab
1158/Mneurosarcoidosis60 mg/dinfliximabMTX
1254/FneurosarcoidosisMTX/AZA45 mg/dinfliximab/adalimumabMTX
1329/Mneurosarcoidosis60 mg/dinfliximabMTX
1456/MaortitisMTX30 mg/dadalimumabMTX
1562/Fneurosarcoidosis30 mg/dinfliximabMTX
Abbreviations: HQ: hydroxichloroquine, MTX: methotrexate, AZA: azathioprine, CyA: cyclosporine A SZP: sulfasalazine, M: male, F: female

The main clinical complications that made necessary the use of anti-TNFa agents were: uveitis (5 cases), neurosarcoidosis (6), bone marrow involvement-pancitopenia (1), skin-lupus pernio (1), systemic-myopathy (1), and aortitis (1).

Most patients had been refractory to corticosteroids and at least one immunosuppressive drug. However, in 3 patients with neurosarcoidosis anti-TNFa agents were prescribed along with corticosteroids as the initial therapy. Besides high-dose prednisone, patients had received the following drugs: i.v. methylprednisolone (500–1000 mg for 3 consecutive days) (4 cases) methotrexate (10 cases), cyclosporine (1 case), azathioprine (3 cases), sulfasalazine (2 cases), and hydroxychloroquine (3 cases).

Anti-TNFa drugs were associated to an immunosuppressive agent (methotrexate, or azathioprine). Infliximab was the most commonly anti-TNFa drug used in this series- in 12 cases (3–5 mg/kg/i.v. at 0, 2, 6 and then every 4–8 weeks). Adalimumab was administered in the other 3 patients (40 mg/sc EOW or EW if necessary). Infliximab was discontinued in 2 cases because of inefficacy and in another 2 due to adverse events (severe rash and gastrointestinal intolerance, respectively). In these 4 cases, infliximab was switched to adalimumab. Adalimumab was discontinued in 1 of 7 cases because of development of a lupus-like syndrome. After a mean time of anti-TNFa therapy of 25 ± 20 months (range 1–72), complete clinical remission was achieved in 9 cases and partial improvement in the remaining 6 patients. Of major importance, in most patients anti-TNFa treatment allowed withdrawal or 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.

Conclusion:

Infliximab and adalimumab appear to be effective and safe drugs in the management of severe and refractory sarcoidosis.

To cite this abstract, please use the following information:
Perez-Martin, Inés, Blanco, Ricardo, Rueda, Javier, Bejerano, Carmen, Pompei, Orlando, Gonzalez-Vela, M. Carmen, et al; Anti-TNF Therapy in 15 Patients with Severe and Refractory Sarcoidosis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1968
DOI:

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