Efficacy of Adalimumab in Chronically Active and Symptomatic Patients with Sarcoidosis

Kamphuis, Lieke; Lam-Tse, Wai-Kwan; Dik, Willem A.; Daele, Paul La van; Biezen, Paula van; Kwekkeboom, Dik J.; Kuijpers, Robert W A M; Hooijkaas, Herbert; Laar, Jan A M van; Bastiaans, Jeroen; Baarsma, G.S.; Hagen, P. Martin van

doi:10.1164/ajrccm.184.10.1214

Cited by 44 publications

(15 citation statements)

References 11 publications

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“…Since both sarcoidosis and Crohn's disease are granulomatous conditions, it seems logical to follow the regimen developed for Crohn's disease. Several open label studies have employed a higher dose of adalimumab [56,92,93]. These studies have reported an improvement with treatment.…”

Section: Anti-tnf Agentsmentioning

confidence: 99%

Established and experimental medical therapy of pulmonary sarcoidosis

et al. 2013

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The treatment options for pulmonary sarcoidosis have increased over the past 10 years. As new treatments have been introduced, the best way to assess and compare treatments remains unknown. The goal of this review is to discuss the standard treatments for pulmonary sarcoidosis, including glucocorticoids, and cytotoxic agents, such as methotrexate, azathioprine and leflunomide, and compare them to the newer biological agents, such as infliximab and adalimumab. We also discuss some novel treatments which are currently being evaluated. To compare these different regimens, we look at the measures used to assess response. These include pulmonary function, chest imaging, steroid sparing potential and, more recently, improvements in quality of life measures. While there is, as yet, no standard assessment for response, there is a growing consensus that response to treatment may include improvement of one or more of the following: forced vital capacity, chest imaging and steroid sparing. Several drugs used for pulmonary sarcoidosis have demonstrated improvement in one or more of these measures.

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Section: Anti-tnf Agentsmentioning

confidence: 99%

Established and experimental medical therapy of pulmonary sarcoidosis

et al. 2013

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“…Compared to infliximab, it appeared to be less effective, 80 but that may be a reflection of the lower doses used in the early treatment protocols. 79 With the use of higher doses, similar to those employed in Crohn's disease, 81,82 the drug appears to be quite effective in refractory ocular sarcoidosis, 83 including in seven of eight patients with optic neuropathy. 84 Since the drug is a humanized antibody, it has been used in patients who had previous toxicity with infliximab.…”

Section: Management Of Neuro-ophthalmic Sarcoidosismentioning

confidence: 99%

Neuro-ophthalmic sarcoidosis

Baughman¹,

Weiss²,

Golnik³

2012

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Neuro-ophthalmic disease occurs in about a third of patients with neurosarcoidosis. Optic nerve involvement is the most common manifestation, but other cranial nerves and the optic chiasm can be involved. However, there are several other common diseases that cause optic neuropathy, including multiple sclerosis. The diagnosis of sarcoidosis can often be made based on the multi-organ nature of the disease and ancillary testing. Most patients with neuro-ophthalmic sarcoidosis require systemic therapy. While corticosteroids are usually the first step in therapy, cytotoxic agents such as methotrexate and azathioprine have been useful as steroid-sparing agents for chronic disease. The monoclonal antibodies directed against tumor necrosis factor have been reported as effective in refractory cases of neuro-ophthalmic disease.

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“…Studies using other immunosuppressive agents demonstrated only slight improvements in lung function, i.e. a mean change of FVC of +200 ml in a retrospective study with leflunomid [26], an improvement in FVC of +3.3% in 18 patients treated with pentoxifylline [6] and no change in lung function in a case series with adalimumab [27]. …”

Section: Discussionmentioning

confidence: 99%

Effect and Safety of Mycophenolate Mofetil in Chronic Pulmonary Sarcoidosis: A Retrospective Study

2012

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Background: Treatment of chronic pulmonary sarcoidosis (CPS) is challenging and often requires long-term therapy with systemic corticosteroids and supplementary use of steroid-sparing agents. Objective: To examine the efficiency and safety of mycophenolate mofetil (MMF) as a steroid-sparing agent in patients with CPS. Methods: We conducted a retrospective study of patients with biopsy-proven pulmonary sarcoidosis, who were treated with MMF and systemic corticosteroids for >6 months between 2004 and 2010. Corticosteroid dose, pulmonary function parameters and radiological and clinical follow-up before and after treatment with MMF were assessed. Results: Ten patients received MMF for >6 months. MMF was introduced due to side effects (5/10 patients) and due to an inadequate response to prior therapy (5/10 patients). Median duration of treatment with MMF was 31 months (range 8-66). Therapeutic MMF plasma trough levels of 1-3 mg/l were reached with daily doses of 1,722 ± 440 mg MMF. Daily corticosteroid dose could be significantly reduced from 14.3 ± 13.3 to 6.5 ± 2.3 mg prednisolone during treatment. During follow-up, pulmonary function, symptoms and radiological signs improved in 4 patients, while 6 patients remained stable. Median change in FVC was +8.5 % (range -2 to 16). No severe adverse events that were related to combined immunosuppressive therapy occurred. Conclusion: This study indicates that the addition of MMF to corticosteroids is a viable and safe treatment option in CPS. MMF allows a significant reduction of maintenance corticosteroids to levels <10 mg/day while preserving a stable or improved clinical condition.

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Efficacy of Adalimumab in Chronically Active and Symptomatic Patients with Sarcoidosis

Cited by 44 publications

References 11 publications

Established and experimental medical therapy of pulmonary sarcoidosis

Established and experimental medical therapy of pulmonary sarcoidosis

Neuro-ophthalmic sarcoidosis

Effect and Safety of Mycophenolate Mofetil in Chronic Pulmonary Sarcoidosis: A Retrospective Study

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