Nonsteroidal therapy of sarcoidosis

Abstract

Purpose of review None of the medications used in clinical practice to treat sarcoidosis have been approved by the regulatory authorities. Understanding how to use disease-modifying antisarcoid drugs, however, is essential for physicians treating patients with sarcoidosis. This review summarizes the recent studies of medications used for sarcoidosis with a focus on nonsteroidal therapies. Studies from 2006 to 2013 were considered for review to update clinicians on the most relevant literature published over the last few years. Recent findings Several recently published pieces of evidence have helped expand our ability to more appropriately sequence second-line and third-line therapies for sarcoidosis. For instance, methotrexate and azathioprine may be useful and well tolerated medications as second-line treatment. Mycophenolate mofetil might have a role in neurosarcoidosis. TNF-α blockers and other biologics seem to be well tolerated medications for the most severely affected patients. Summary Corticosteroids remain the first-line therapy for sarcoidosis as many patients never require treatment or only necessitate a short treatment duration. Second-line and third-line therapies described in this article should be used in patients with progressive or refractory disease or when life-threatening complications are evident at the time of presentation.

Adalimumab-induced lupus serositis

“…With novel use of these biological agents to treat conditions such as sarcoidosis,1 in addition to their approved use for RA, PA, AS, JIA and IBD, it is imperative that specialists are aware of the risk of a lupus-like syndrome. It may be prudent to introduce pretreatment serological evaluation for SLE.…”

“…They are also rarely used as third-line therapy in the treatment of sarcoidosis 1. However, these agents have a variety of serious adverse effects including infection, reactivation of tuberculosis (TB) and immunogenicity.…”

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

“…Corticosteroids are first-line treatment for CS, whereas cytotoxic drugs, such as methotrexate, are second-line agents in patients who require prednisone greater than 10 mg/d. [3][4][5] Tumor necrosis factor α inhibitors, such as adalimumab (Humira), are considered in patients with inadequate response or inability to tolerate first-and second-line therapies. 4,6,7 As active sarcoid lesions are typically hypermetabolic, FDG PET/CT offers advantages in the management of patients with sarcoidosis.…”

“…[3][4][5] Tumor necrosis factor α inhibitors, such as adalimumab (Humira), are considered in patients with inadequate response or inability to tolerate first-and second-line therapies. 4,6,7 As active sarcoid lesions are typically hypermetabolic, FDG PET/CT offers advantages in the management of patients with sarcoidosis. 8 This case demonstrates FDG PET/CT evidence of efficacious treatment of CS with adalimumab.…”

Interstitielle Nephritis bei rheumatischen Erkrankungen

“…Bei der Sarkoidose kommen in erster Linie Glukokortikoide (0,5-1,0 mg/kg/ Tag mit Reduktion nach etwa 1-2 Wochen und Erhaltungstherapie je nach Ansprechen) in Frage, steroidsparende Medikamente wie Azathioprin, Mycophenolatmofetil, Hydroxychloroquin oder auch Infliximab können bei steroidrefraktä-ren Verläufen mit Nierenbeteiligung aufgrund fehlender randomisierter, kontrollierter prospektiver Studien bis dato nur mit geringer Evidenz empfohlen werden [21,25]. Die IgG4-assoziierte Erkrankung spricht in der Regel gut auf Glukokortikoide an, bei refraktären Verläufen oder Rezidiven wurden Azathioprin und Rituximab erfolgreich eingesetzt [23].…”