Adalimumab May Safely Treat Sarcoidosis in Hepatitis C, Case Report Suggests

People with hepatitis C who develop sarcoidosis may be safely treated with adalimumab, marketed by Abbvie as Humira, a case report suggests.

The case was described in a study, “Sarcoidosis with concomitant hepatitis C infection treated successfully with adalimumab,” which was published in the Journal of the German Society of Dermatology.

Sarcoidosis is a rare chronic inflammatory disease of unknown origin that may affect different organs in the body. When it occurs in people who also have hepatitis C — liver inflammation caused by the hepatitis C virus, or HCV — sarcoidosis tends to primarily affect the respiratory system (75% of the cases) and skin (60% of the cases).

“In this clinical setting, the treatment is challenging,” the researchers said. They noted that the effects of standard medications used to treat sarcoidosis, such as steroids, are unclear — or even thought to be harmful — in patients with hepatitis C.

In this new report, researchers from the Philipps-University Marburg in Germany described the case of an individual with hepatitis C who developed sarcoidosis and was safely treated with adalimumab.

The 55-year-old Moroccan woman had recently been diagnosed with hepatitis C and had a facial skin lesion that resulted from a car accident.

The woman had started anti-viral treatment with pegylated interferon alpha and ribavirin (sold as Rebetron, among other brand names) to manage her hepatitis. Shortly after that, she started to develop small nodules under the skin that ran along the scars she had on her face.

Lab tests and a tissue sample biopsy of the nodules growing on her facial lesions confirmed the diagnosis of scar sarcoidosis. She was found to have a form of the condition in which the disease starts affecting skin that has been scarred in a previous incident. Chest x-rays and computed tomography (CT) scans performed afterward also revealed she had mild lung involvement.

The team was unable to determine if, in this case, sarcoidosis was triggered by the previous anti-viral treatment that the patient had received. Nonetheless, given that her symptoms manifested only two years after treatment withdrawal, the team believed that the anti-viral treatment had a marginal effect on sarcoidosis development.

Physicians decided she should start treatment with adalimumab, an antibody that blocks the activity of tumor necrosis factor (TNF) alpha. That is a molecule that mediates and regulates immune and inflammatory responses, and is often overactive in patients with different types of autoimmune and inflammatory diseases.

Adalimumab was administered by under-the-skin (subcutaneous) injection for a period of 24 weeks, initially at a dose of 80 mg. The was followed by 40 mg every 14 days as maintenance therapy.

After 20 weeks of treatment, the team could observe a significant regression of the inflammatory skin lesions. She did not experience any adverse reactions, such as HCV viremia (presence of virus in the blood) or increased blood levels of liver enzymes, which are often a sign of liver inflammation or damage, the team noted.

During the next 72 weeks following the treatment, the skin nodules did not relapse. In addition, all signs of lung involvement that were initially visible in CT scans disappeared after treatment with adalimumab.

“To the best of our knowledge, this is the first case to be reported on treatment with adalimumab of sarcoidosis with concomitant HCV infection,” the researchers said. “Adalimumab proved to be an effective and safe treatment option.”