Case Report Links MS Therapy Daclizumab to Pulmonary Sarcoidosis

Case Report Links MS Therapy Daclizumab to Pulmonary Sarcoidosis

A recent study has reported on a multiple sclerosis (MS) patient who developed pulmonary sarcoidosis after receiving the relapsing-remitting MS (RRMS) therapy daclizumab.

The report “Pulmonary Sarcoidosis in a patient with Multiple Sclerosis on daclizumab monotherapy,” was published in Multiple Sclerosis and Related Disorders.

Daclizumab is a prescription medicine used to treat adults with relapsing forms of MS. Because of its risks, this immune system-targeting drug is used mostly in people who have tried two or more MS medicines without success.

This RRMS medication increases the number of a specific type of immune cells (CD56 natural killer cells), which have been shown to be present in the lungs of patients with pulmonary sarcoidosis and are believed to be involved in the inflammatory response associated with sarcoidosis.

In a previous review of daclizumab, the Center for Drug Evaluation and Research (a division of the U.S. Food and Drug Administration), identified nine cases of sarcoidosis among several RRMS trial groups, with four probable, but not definitive, cases. Moreover, several sarcoidosis cases had been reported previously following the use of interferon-β, including one in a 30-year-old woman with multiple sclerosis who developed pulmonary and cutaneous sarcoidosis.

Now, King’s College Hospital researchers reported a case of a 45-year-old man who developed systemic, non-specific symptoms following long term use of daclizumab and was subsequently diagnosed with sarcoidosis.

The patient presented with a 2-month history of fevers, night sweats and non-productive cough. He had been on a series of consecutive trials of daclizumab for RRMS, totaling 79 months (12-months placebo-controlled, 12-months dose-blinded, 55-months open-label of 150 mg monthly subcutaneously). He had experienced three relapses in the three years prior to commencing the trials, but remained relapse-free during them. Importantly, he had no significant co-morbidity.

Two months following temporary daclizumab suspension, spirometry test — a pulmonary function test measuring lung function — demonstrated moderate lung obstruction.

At this stage, all symptoms except the non-productive cough had resolved and a clinical diagnosis of sarcoidosis was made.

“Considering subjective and objective evidence of improvement following daclizumab cessation, it was reasoned that daclizumab was the probable cause and it was therefore permanently discontinued,” the authors wrote.

Despite this being the only case of pulmonary sarcoidosis after daclizumab therapy to date, further research is still necessary especially since sarcoidosis-linked molecular players already have been identified.

“As new immunomodulatory therapies continue to be licensed for use in multiple sclerosis, it is important to remain vigilant for new, unexpected associations relating to these medications,” researchers wrote.

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