Highlights
- •In some patients with sarcoidosis, anti-TNF-α antibodies induce prolonged medication-free remissions.
- •The sustained capacity to remain off corticosteroids during anti-TNF-α therapy may be a favorable prognostic indicator for maintained drug-free disease remission.
- •These findings may lead to optimization of TNF-α inhibitor use and better understanding of the role of TNF-α in sarcoidosis.
Abstract
Background
Monoclonal antibodies against tumor necrosis factor-alpha (TNF-α) have been used successfully
in the treatment of sarcoidosis, but optimal duration of their use is unclear. Published
studies have consistently suggested that withdrawal of therapy typically results in
prompt disease relapse. The aim of this study is to identify and characterize patients
with sarcoidosis in whom medication-free disease remissions were induced and sustained
following treatment with and subsequent discontinuation of anti-TNF-α antibodies.
Methods
A retrospective chart review was conducted to identify patients satisfying three criteria:
(1) histopathological documentation of sarcoidosis; (2) disease remission induced
by anti-TNF-α antibodies, since discontinued; and (3) subsequent maintained clinical,
radiological, and laboratory remission for at least one year without ongoing immunomodulatory
medications.
Results
Eight patients whose sarcoidosis remained in medication-free remissions were identified.
The duration of remissions ranged from 22 to 132 months. All patients had previously
had inadequate response to corticosteroid therapy and at least one steroid-sparing
agent, prompting the use of anti-TNF-α antibodies. Before anti-TNF-α therapy was discontinued,
all eight patients had been able to remain off systemic corticosteroid therapy for
at least a year (range 12–130 months).
Conclusions
These observations suggest that in select sarcoidosis patients, anti-TNF-α antibodies
may induce prolonged medication-free remissions. The sustained capacity to remain
off corticosteroids during anti-TNF-α therapy may be a favorable prognostic indicator
for maintained disease remission. These findings may help to develop principles for
optimal utilization of these agents and to shed light onto the potential pathogenic
role of TNF-α in this disease.
Keywords
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Article info
Publication history
Published online: November 23, 2022
Accepted:
November 16,
2022
Received in revised form:
November 2,
2022
Received:
July 13,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
