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


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


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.


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.


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

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