The study, “Efficacy and Tolerance of Anti–Tumor Necrosis Factor α Agents in Cutaneous Sarcoidosis, A French Study of 46 Cases,” was published in the journal JAMA Dermatology.
Small skin sarcoidosis lesions are typically treated with topical administration of steroids, tetracycline antibiotics, or hydroxychloroquine. However, the effectiveness of these therapies has never been widely explored. Indeed, many of these drugs are often found to be ineffective for many patients.
Another type of therapy that has been studied to treat sarcoidosis is anti-TNF agents. These therapeutics impair the immune system’s response, and also the formation of granulomas (aggregates of immune B-cells), which are the hallmark of sarcoidosis.
Now, researchers evaluated the long-term efficacy of anti-TNF agents to treat skin sarcoidosis. A total of 46 sarcoidosis patients with skin lesions were included in the study. Their clinical information was collected from the retrospective and prospective multicenter French database STAT (Sarcoidosis Treated with Anti-TNF).
The authors found the main reason that led to the start of anti-TNF therapy was due to a previous regimen’s failure or adverse effects in 93% of the patients.
The majority of patients (87%) received Remicade, combined with systemic steroids in 28 cases (61%) and immunosuppressants in 32 cases (69.5%).
The overall cutaneous response rate (OCRR) of the patients treated with anti-TNF was 24% after three months, 46% after six months of treatment, and 79% after one year. The use of anti-TNF agents led to a reduction in the use of steroids, with improved response to treatment.
Despite the positive results, 11 patients had to stop treatment due to adverse effects, and 14 patients reported the occurrence of infections. Infections were more frequent in patients treated for internal organ involvement than in those treated for skin lesions.
The team also observed that 44% of the patients relapsed with skin sarcoidosis symptoms after 18 months of treatment discontinuation. Nonetheless, all patients who achieved remission during treatment but relapsed after discontinuing it, achieved remission again upon resuming anti-TNF therapy.
“Anti-TNF agents are effective in cutaneous sarcoidosis, but relapses are frequent after discontinuation,” the researchers wrote. “Clinicians must be aware of infections, especially if patients are being treated with concomitant [systemic steroids] or [immunosuppressive agents],” the team concluded.