Sarcoidosis Induced by Tocilizumab: A Paradoxical Event?

Nutz, A.; Pernet, C.; Combe, Bernard; Cohen, Jean-David

doi:10.3899/jrheum.130278

Cited by 27 publications

(14 citation statements)

References 8 publications

(5 reference statements)

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“…Not only infliximab, but adalimumab, has been shown to induce granulomatous patterns on histopathology, as well as similar findings . More recently, a sarcoidal non‐caseating epithelioid granulomatous pattern was described in a patient on tocilizumab for rheumatoid arthritis who developed painful nodules over the arms and legs …”

Section: Different Histopathological Patternsmentioning

confidence: 60%

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Cutaneous side‐effects of biologics in immune‐mediated disorders: A histopathological perspective

Succaria

Bhawan

2017

The Journal of Dermatology

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Advances in understanding molecular mechanisms and targets in immune regulation have led to the widespread use of biologic targeted therapies, and, as such, reformed the course of many disabling diseases. However, with their expanded use, various side-effects, including cutaneous, have emerged. Many times a clear-cut relationship exists between the drug and the clinical manifestations; however, when a biopsy is warranted, various histopathological patterns may be observed and may cause confusion to the dermatopathologist. The aim of this review is to shed light on the different histopathological patterns observed as a manifestation secondary to biologics.

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Section: Different Histopathological Patternsmentioning

confidence: 60%

“…31 More recently, a sarcoidal non-caseating epithelioid granulomatous pattern was described in a patient on tocilizumab for rheumatoid arthritis who developed painful nodules over the arms and legs. 32…”

Section: Granulomatous Patternmentioning

confidence: 99%

Cutaneous side‐effects of biologics in immune‐mediated disorders: A histopathological perspective

Succaria

Bhawan

2017

The Journal of Dermatology

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“…There are two case reports of sarcoidosis being associated with the use of tocilizumab as treatment for rheumatoid arthritis [21,22]. Whether these are examples of IL6 blockade being ineffective in the development of sarcoidosis or that in some cases, alteration of the immune system with IL6 blockade may predispose to sarcoidosis, remains uncertain [23].…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab in sarcoidosis patients failing steroid sparing therapies and anti-TNF agents

Sharp

Donnelly

Möller

2019

Respiratory Medicine: X

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“…Paradoxically, new-onset sarcoidosis during TCZ treatment has been described in four case-reports. [122][123][124][125] In three cases, there was what was presumed to be TCZinduced sarcoidosis, observed during treatment for RA, at least 1 year after the start of the treatment. Del Giorno et al recently reported TCZ-induced sarcoidosis in a 74-year-old woman treated for giant cell arteritis, which occurred 8 months after TCZ initiation.…”

Section: Tocilizumabmentioning

confidence: 99%

<p>Refractory Sarcoidosis: A Review</p>

Jammal

Jamilloux

Gerfaud‐Valentin

et al. 2020

TCRM

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Sarcoidosis is a multi-system disease of unknown etiology characterized by granuloma formation in various organs (especially lung and mediastinohilar lymph nodes). In more than half of patients, the disease resolves spontaneously. When indicated, it usually responds to corticosteroids, the first-line treatment, but some patients may not respond or tolerate them. An absence of treatment response is rare and urges for verifying the absence of a diagnosis error, the good adherence of the treatment, the presence of active lesions susceptible to respond since fibrotic lesions are irreversible. That is when second-line treatments, immunosuppressants (methotrexate, leflunomide, azathioprine, mycophenolate mofetil, hydroxychloroquine), should be considered. Methotrexate is the only first-line immunosuppressant validated by a randomized controlled trial. Refractory sarcoidosis is not yet a well-defined condition, but it remains a real challenge for the physicians. Herein, we considered refractory sarcoidosis as a disease in which second-line treatments are not sufficient to achieve satisfying disease control or satisfying corticosteroids tapering. Tumor necrosis alpha inhibitors, third-line treatments, have been validated through randomized controlled trials. There are currently no guidelines or recommendations regarding refractory sarcoidosis. Moreover, criteria defining non-response to treatment need to be clearly specified. The delay to achieve response to organ involvement and drugs also should be defined. In the past ten years, the efficacy of several immunosuppressants beforehand used in other autoimmune or inflammatory diseases was reported in refractory cases series. Among them, anti-CD20 antibodies (rituximab), repository corticotrophin injection, and anti-JAK therapy anti-interleukin-6 receptor monoclonal antibody (tocilizumab) were the main reported. Unfortunately, no clinical trial is available to validate their use in the case of sarcoidosis. Currently, other immunosuppressants such as JAK inhibitors are on trial to assess their efficacy in sarcoidosis. In this review, we propose to summarize the state of the art regarding the use of immunosuppressants and their management in the case of refractory or multidrugresistant sarcoidosis.

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Sarcoidosis Induced by Tocilizumab: A Paradoxical Event?

Cited by 27 publications

References 8 publications

Cutaneous side‐effects of biologics in immune‐mediated disorders: A histopathological perspective

Cutaneous side‐effects of biologics in immune‐mediated disorders: A histopathological perspective

Tocilizumab in sarcoidosis patients failing steroid sparing therapies and anti-TNF agents

<p>Refractory Sarcoidosis: A Review</p>

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