Sarcoidosis is a rare inflammatory disease where the immune system is overactive. It is characterized by clumps of immune cells, called granulomas, which build up in different parts of the body and prevent tissues and organs from working as they should. If left untreated, these granulomas can lead to permanent damage.

There is no cure for sarcoidosis, but various therapies can help manage its symptoms. Tumor necrosis factor-alpha (TNF-alpha) inhibitors are one type of therapy, which work by suppressing part of the immune response.

What are TNF-alpha inhibitors?

TNF-alpha is a cytokine, a type of immune protein, that regulates a range of biological processes. It is secreted by immune cells, including those that form granulomas.

It is involved in stimulating the inflammatory response, a process that is normally used to protect the body against infections and in response to injury. In sarcoidosis, too much TNF-alpha is produced and leads to chronic swelling and inflammation that can damage healthy tissues.

TNF-alpha inhibitors block TNF-alpha from triggering the damaging inflammation response. Many of the TNF-alpha inhibitors work by binding to TNF-alpha itself, so that it cannot interact with the receptors that pass the signal to other cells to trigger inflammation.

TNF-alpha inhibitors may also be referred to as anti-TNF-alpha or TNF-alpha antagonists.

Types of TNF-alpha inhibitors

There are several types of TNF-alpha inhibitors that are approved to treat other conditions, such as inflammatory bowel disease (IBD) or arthritis. They are used off-label to treat sarcoidosis.

Remicade (infliximab) and Humira (adalimumab) are two of the most common TNF-alpha inhibitors used as a therapy for sarcoidosis. They may be prescribed if the patient is not responding to other therapies. They may also be used as a corticosteroid-sparing therapy, as these can have serious side-effects if used long term.

Other TNF-alpha inhibitors are Simponi (golimumab), Enbrel (etanercept), Cimzia (certolizumab pegol), pentoxifylline, and thalidomide.

TNF-alpha inhibitors in clinical trials for sarcoidosis

Several clinical trials have been conducted supporting the safety and effectiveness of TNF-alpha inhibitors in sarcoidosis.

For example, a Phase 3 clinical trial (NCT00073437) examined the effects of Remicade compared to a placebo in 138 sarcoidosis patients with pulmonary involvement. Results of the trial, published in the American Journal of Respiratory and Critical Care Medicine in 2006, suggested that Remicade could significantly improve some lung symptoms of sarcoidosis. The improvement was more pronounced in patients who had high levels of C-reactive protein in their blood, a marker for inflammation.

Other information

As TNF-alpha inhibitors affect the immune system, patients using these medications have an increased risk of infections.

TNF-alpha inhibitors are generally administered through an injection or as an infusion. A common side effect can be injection site reactions or infusion reactions to the treatment.

Other common side effects of TNF-alpha inhibitors include nausea, heartburn, headaches, runny nose, white patches in the mouth, flushed skin, and vaginal itching.

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