TNF Antagonists Are Effective at Treating Sarcoidosis, but Adverse Events Are a Concern

Tumor necrosis factor (TNF) antagonists are effective therapies in a significant proportion of patients with severe and refractory sarcoidosis, a new study shows. However, they also are associated with adverse events such as infections and allergic reactions.

The study titled, “Efficacy and safety of tumor necrosis factor antagonists in refractory sarcoidosis: A multicenter study of 132 patients,” was published in the journal Seminars in Arthritis and Rheumatism.

Drugs that target TNF have been studied as potential therapeutic agents for sarcoidosis.

Prior studies have indicated that TNF plays a role in the inflammatory processes that characterized sarcoidosis. Alveolar macrophages, which are immune cells of the lungs, release TNF in patients with active lung disease.

However, the use of TNF antagonists has been associated with several adverse events, infections, and malignancies.

The off-label use of TNF antagonists in the treatment of refractory sarcoidosis is increasing, despite the fact that data on their efficacy and safety in this patient population are still lacking.

In order to address this question, researchers investigated the effectiveness and safety of two TNF antagonists – infliximab and adalimumab – in sarcoidosis patients.

The team retrospectively analyzed 132 sarcoidosis patients who received treatment with infliximab (91%) or adalimumab (6%).

Researchers found that approximately two-thirds (64%) of patients had either a complete or partial response to treatment with a TNF antagonist, particularly patients whose brain, heart, skin, and upper respiratory tract were affected by the disease.

No differences in effectiveness were found among patients using anti-TNF and patients using anti-TNF combined with immunosuppressant agents.

Furthermore, patients using TNF antagonists required a lower dose of prednisone, a corticosteroid prescribed in sarcoidosis patients, at the end of the follow-up period.

In total, 52% of the patients assessed experienced adverse events, with the most frequent being infections (36% of patients) and allergic reactions (8%).

Treatment interruption due to adverse events or because it was not working was reported in 23% of the patients. Among these patients, 13 relapsed within 14 months, on average. Patients receiving anti-TNF therapies are known to be at risk of relapse during treatment or after drug withdrawal.

Researchers also found that “pulmonary involvement was associated with a lower clinical response to anti-TNF” in patients with sarcoidosis.

Overall, “the present study has demonstrated TNF-antagonist efficiency in the majority of patients though infections and relapses rates were rather high in long-lasting and long-treated cases,” the team concluded.