FDG PET/CT Evidence of Effective Treatment of Cardiac Sarcoidosis With Adalimumab

Miller, Christina T.; Sweiss, Nadera J.; Lu, Yang

doi:10.1097/rlu.0000000000001124

Cited by 14 publications

(9 citation statements)

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“…However, decreased perfusion at rest is not specific nor sensitive for CS diagnosis; many CS can have normal or even increased perfusion. Our experience also showed that, with optimal suppression of physiologic myocardial 18 F-FDG uptake, the rest myocardial perfusion study or reorientation/reconstruction of cardiac 18 F-FDG PET/CT images might not be needed (4,5). The authors recommended interpretation of concurrent myocardial perfusion and 18 F-FDG PET images mainly based on the data from Brigham and Women's Hospital, which included 118 patients over a 5-y period who underwent ,24-h HFHPVLC diet followed by a fast of at least 3 h before 18 F-FDG PET and 82 Rb myocardial perfusion PET (6).…”

Section: Referencesmentioning

confidence: 89%

Role of ¹⁸F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

Lü¹,

Sweiss²

2018

J Nucl Med

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The War Is Opened: PSMA vs. 64 CUCL 2 vs. Choline PET/CT TO THE EDITOR: I have read with great interest the paper by Piccardo et al. (1) and the editorial by Ceci et al. (2) recently published in your journal. After a careful analysis of the published data, some comments seem necessary. First, a specific 18 F-choline acquisition protocol would improve the detection of recurrent prostate cancer, either for prostatic fossae or for lymph nodes. PET acquisition at only 20 min after 18 F-choline injection, as reported by the authors (2), cannot be considered as a standard. In a recent review, 21 of 29 (72%) studies that focused on 18 F-choline PET or PET/CT reported a late (after 60 min) wholebody scan, whereas only 8 of 29 (28%) reported acquisition at 10-15 min after tracer injection (3). In our recent experience (4) in 75 patients who underwent both an early static and a late whole-body acquisition, we found that in the case of low prostate-specific antigen levels (,2 ng/mL), early 18 F-choline PET/CT scans detected recurrent disease in prostatic fossae in 15 subjects. Conversely, late images were positive in only 4 patients. Therefore, in the case of prostatic fossae recurrence, a specific acquisition protocol would be useful to improve the detection rate up to 70%. Furthermore, Oprea-Lager et al. (5) reported that a single-time-point SUV measurement 30 min after injection was a reasonable alternative for predicting the enlarged pelvic lymph nodes. However, no dedicated European guidelines are currently available for 18 F-choline PET/CT examination. Second, the authors did not report any data about 64 CuCl 2 acquisition (early; after 4 h; or late, after 24 h) for the interpretation of the images. This information would be useful for the repeatability of the study and also for understanding the correct scheduling of patients. Third, the comments by Ceci et al. (2) are mainly focused on the comparison between 64 CuCl 2 and prostate-specific membrane antigen (PSMA)-based radiopharmaceuticals. Because most of the available data about PSMA-directed PET use 68 Ga-PSMA-11-a radiopharmaceutical agent with a urinary excretion-there is a loss of information for prostatic fossae recurrence. A study performed by Uprimny et al. (6) reported that when early (after 4-8 min) and late (after 60 min) 68 Ga-PSMA-11 PET/CT were used, an early 68 Ga-PSMA-11 scan was able to identify the presence of prostatic fossae recurrence in 50 patients, with a gain of detection rate more than 50% than late acquisition. Again, the acquisition protocol is useful for the correct interpretation of PET/CT findings. In our opinion, the comparison between 64 CuCl 2 and 68 Ga-PSMA-11 or 18 F-fluciclovine is mandatory, however:

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Section: Referencesmentioning

confidence: 89%

Role of ¹⁸F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

Lü¹,

Sweiss²

2018

J Nucl Med

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“…Until 2019, there were no randomized trials on TNFα antagonists in CS, and only a few cases reports or series had shown the potential benefit of TNFα antagonists (17)(18)(19)(20)(21)(22). The ATTACH (Anti-TNF Therapy Against Congestive Heart Failure) trial (34) found worsening of heart failure in patients treated by high-dose infliximab for congestive heart failure with other causes than sarcoidosis limiting its use in cardiac inflammatory conditions such as CS.…”

Section: Discussionmentioning

confidence: 99%

“…In severe or refractory disease, TNFα antagonists are effective in ocular (13), neurological (14), osseous (15), and pulmonary (16,17), sarcoidosis. In CS, a few cases reports (18)(19)(20)(21)(22) and five cohort studies (23)(24)(25)(26)(27) have shown benefits of CT with or without IT in patients with severe and/or refractory cardiac involvement. Although there has been no randomized controlled study, some articles and expert opinions have suggested that TNFα antagonists for severe or refractory CS might be an option in case of CT or IT failure (28-30).…”

Section: Introductionmentioning

confidence: 99%

Case Report: TNFα Antagonists Are an Effective Therapy in Cardiac Sarcoidosis

Stievenart¹,

Guenno²,

Ruivard³

et al. 2021

Front. Cardiovasc. Med.

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Introduction: Cardiac sarcoidosis (CS) is a life-threatening disease in which clear recommendations are lacking. We report a case series of CS successfully treated by tumor necrosis factor (TNF)α antagonists.Methods: We conducted a single-center retrospective study of our patients with CS treated by TNFα antagonists.Results: Four cases (4/84, 4.7%) were found in our database. Mean age was 40 years (range 34–53 years), and all were Caucasian men. Mean follow-up was 54.75 months (range 25–115 months). All patients received corticosteroid therapy (CT) and immunosuppressive therapy (IT). TNFα antagonists (infliximab or adalimumab) were started after the first or second CS relapse under CT and IT. One patient experienced relapse under TNFα antagonists (isolated decreased left ventricular ejection) and responded to a shorter interval of TNFα antagonist infusion. CT was discontinued in three patients treated with TNFα antagonists without relapse or major cardiac events during follow-up. No serious adverse event occurred in our case series, possibly due to dose sparing and frequent arrest of CT.Conclusion: TNFα antagonists were effective in refractory and/or relapsing CS treated by corticosteroids and/or immunosuppressive agents, without serious adverse events, and should be considered earlier in CS treatment scheme.

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“…However, disease remained refractory to all these agents and resolved with anti-TNF therapy (adalimumab). TNF-alpha plays an important role in the genesis and perpetuation of granulomas, and its inhibitors have been utilized in the management of refractory sarcoid 10, 11. To the best of our knowledge this is the first case of refractory VT in CS, successfully managed with anti-TNF therapy.…”

Section: Discussionmentioning

confidence: 99%

Management of refractory ventricular tachycardia due to cardiac sarcoidosis—A biologic approach

Theodore

Saggu

Yalagudri

et al. 2019

HeartRhythm Case Reports

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FDG PET/CT Evidence of Effective Treatment of Cardiac Sarcoidosis With Adalimumab

Cited by 14 publications

References 7 publications

Role of ¹⁸F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

Role of ¹⁸F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

Case Report: TNFα Antagonists Are an Effective Therapy in Cardiac Sarcoidosis

Management of refractory ventricular tachycardia due to cardiac sarcoidosis—A biologic approach

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FDG PET/CT Evidence of Effective Treatment of Cardiac Sarcoidosis With Adalimumab

Cited by 14 publications

References 7 publications

Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

Case Report: TNFα Antagonists Are an Effective Therapy in Cardiac Sarcoidosis

Management of refractory ventricular tachycardia due to cardiac sarcoidosis—A biologic approach

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Role of ¹⁸F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

Role of ¹⁸F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus