Effectiveness and safety of infliximab in cardiac Sarcoidosis

Bakker, A.L.M.; Mathijssen, Harold; Azzahhafi, Jaouad; Swaans, Martin J.; Veltkamp, Marcel; Keijsers, Ruth G.; Akdim, Fatima; Post, Martijn C.; Grutters, Jan C.

doi:10.1016/j.ijcard.2021.02.022

Cited by 23 publications

(18 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, studies on TNFα antagonists have shown interesting outcomes in patients with resistant or relapsing CS. [47][48][49][50][51] Further studies, including comparative groups between CT, IT and TNFα antagonists' treated patients, are needed to clarify which treatments schemes could be recommended.…”

Section: Discussionmentioning

confidence: 99%

Cardiac sarcoidosis: systematic review of the literature on corticosteroid and immunosuppressive therapies

et al. 2021

View full text Add to dashboard Cite

BackgroundCardiac sarcoidosis (CS) is a life-threatening condition in which clear recommendations are lacking. We aimed to review systematically the literature on cardiac sarcoidosis treated by corticosteroids and/or immunosuppressive agents in order to update the management of CS.MethodsUsing Pubmed, Embase and Cochrane Library databases, we found original articles on corticosteroid and/or standard immunosuppressive therapies for CS which provided at least fair SIGN overall assessment of quality and analyse the relapse rate, major cardiac adverse events (MACEs) and adverse events. We base our methods on Prisma statement and checklist.ResultsWe retrieved 21 studies. Mean quality provided by SIGN assessment was 6.8/14 (range 5–9). Corticosteroids appeared to have a positive impact on left ventricular function, atrioventricular block, and ventricular arrhythmias. For corticosteroids alone, nine (45%) studies (n=351) provided data on relapses, representing an incidence of 34% (n=119). Three studies (14%, n=73) provided data on MACEs (n=33), representing 45% of MACEs in patients treated by corticosteroid alone. Nine studies provided data on adjunctive immunosuppressive therapy in which four studies (n=78) provided data on CS relapse, representing an incidence of 33% (n=26). Limitations consisted in no randomised control trial retrieved and unclear data on MACEs in patients treated by combined immunosuppressive agents and corticosteroids.ConclusionsCorticosteroids should be started early after diagnosis but the exact scheme is still unclear. Studies concerning adjunctive conventional immunosuppressive therapies are lacking and benefits of adjunctive immunosuppressive therapies are unclear. Homogenous data on CS long-term outcomes under corticosteroids, immunosuppressive therapies and other adjunctive therapies are lacking.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac sarcoidosis: systematic review of the literature on corticosteroid and immunosuppressive therapies

et al. 2021

View full text Add to dashboard Cite

show abstract

“…None had worsening HF. No serious side effects were noted [33]. Rosenthal, et al reported 28 cases of CS followed for a mean of 4.1 years [231].…”

Section: Tumor Necrosis Factor Alpha (Tnf-α) Antagonistsmentioning

confidence: 99%

“…In a single center study in the Netherlands, 22 patients with CS received IFX between 2016-2019 (dose 5 mg/kg at week 0, 2, and subsequently every 4 weeks) [33]. At a mean follow-up of 18.9 months (6 to 44 months), 18/22 (82%) had responded and median SUVmax on 18 FDG-PET decreased (improved) from 5.2 to 2.3 (p = 0.015).…”

Section: Tumor Necrosis Factor Alpha (Tnf-α) Antagonistsmentioning

confidence: 99%

“…As will be discussed in detail later, steroids have been associated with favorable responses in large retrospective trials of CS [23][24][25] but failures or relapses have led to the use of Immunosuppressive Agents (IA) [26], usually in addition to steroids [27][28][29]. Further, given the possible role of tumor necrosis factor-a (TNF-) in the pathogenesis of sarcoidosis [30], TNF- antagonists have been used to treat CS, usually in cases failing steroids or other IA [31][32][33][34]. However, data regarding the use of (TNF-) antagonists are even more limited than steroids or IA.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac involvement in sarcoidosis: Evolving concepts in diagnosis and treatment

P¹,

C²,

S³

et al. 2021

J Cardiovasc Med Cardiol

View full text Add to dashboard Cite

Clinically evident cardiac involvement has been noted in at least 2 to 7% of patients with sarcoidosis, but occult involvement is much higher (> 20%). Cardiac Sarcoidosis (CS) is often not recognized as an antemortem, as sudden death may be the presenting feature. Cardiac involvement may occur at any point during the course of sarcoidosis and may occur in the absence of pulmonary or systemic involvement. Sarcoidosis can involve any part of the heart. The prognosis of CS is related to the extent and site(s) of involvement. Most deaths due to CS are due to arrhythmias or conduction defects, but granulomatous infiltration of the myocardium may cause progressive and ultimately lethal cardiomyopathy. The definitive diagnosis of isolated CS is difficult and the yield of Endomyocardial Biopsies (EMB) is low. Treatment of CS is often warranted even in the absence of histologic proof. Radionuclide scans are integral to the diagnosis. Gadolinium-enhanced cardiac magnetic imaging scans and 18Fluorodeoxyglucose (18FDG)-Positron Emission Tomography (PET) are the key imaging modalities to diagnose CS. The prognosis of CS is variable, but mortality rates of untreated CS are high. Randomized therapeutic trials have not been done, but corticosteroids (alone or combined with additional immunosuppressive agents) are the mainstay of therapy. Additionally, anti-arrhythmic agents and therapy for heart failure are often required. Because of the potential for sudden cardiac death, an Implantable Cardioverter-Defibrillator (ICD) should be placed in any patient with CS and serious ventricular arrhythmias or heart block and should be considered for cardiomyopathy. Cardiac transplantation is a viable option for patients with end-stage CS refractory to medical therapy.

show abstract

“…More recently, several biologic agents have been evaluated in the treatment of CS. Infliximab, a chimeric monoclonal antibody that inhibits tumor necrosis factor alpha, has emerged as a potential therapy for CS, with a recent study of 22 patients with refractory CS on standard therapy showing a significant reduction in cardiac inflammation on cardiac PET and improvement in left ventricular function after addition of infliximab [58]. Another agent with potential utility in CS is rituximab, a chimeric monoclonal antibody targeting CD20 on B cells.…”

Section: Treatment Of Csmentioning

confidence: 99%

PET Imaging in Cardiac Sarcoidosis: A Narrative Review with Focus on Novel PET Tracers

et al. 2021

View full text Add to dashboard Cite

Sarcoidosis is a multi-system inflammatory disease characterized by the development of inflammation and noncaseating granulomas that can involve nearly every organ system, with a predilection for the pulmonary system. Cardiac involvement of sarcoidosis (CS) occurs in up to 70% of cases, and accounts for a significant share of sarcoid-related mortality. The clinical presentation of CS can range from absence of symptoms to conduction abnormalities, heart failure, arrhythmias, valvular disease, and sudden cardiac death. Given the significant morbidity and mortality associated with CS, timely diagnosis is important. Traditional imaging modalities and histologic evaluation by endomyocardial biopsy often provide a low diagnostic yield. Cardiac positron emission tomography (PET) has emerged as a leading advanced imaging modality for the diagnosis and management of CS. This review article will summarize several aspects of the current use of PET in CS, including indications for use, patient preparation, image acquisition and interpretation, diagnostic and prognostic performance, and evaluation of treatment response. Additionally, this review will discuss novel PET radiotracers currently under study or of potential interest in CS.

show abstract

Effectiveness and safety of infliximab in cardiac Sarcoidosis

Cited by 23 publications

References 21 publications

Cardiac sarcoidosis: systematic review of the literature on corticosteroid and immunosuppressive therapies

Cardiac sarcoidosis: systematic review of the literature on corticosteroid and immunosuppressive therapies

Cardiac involvement in sarcoidosis: Evolving concepts in diagnosis and treatment

PET Imaging in Cardiac Sarcoidosis: A Narrative Review with Focus on Novel PET Tracers

Contact Info

Product

Resources

About