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[TNFα blocking agents and sarcoidosis: an update].
1Service de rhumatologie, pôle de pathologies aiguës et chroniques, transplantation, éducation (PACTE), hôpital Minjoz, CHU, 25000 Besançon, France. etoussirot@chu-besancon.fr
La Revue De Medecine Interne
|June 1, 2010
Summary
Tumor necrosis factor-alpha (TNFα) blocking agents show efficacy in extra-pulmonary sarcoidosis but not pulmonary disease. Paradoxical sarcoidosis cases suggest a class effect of these TNFα inhibitors.
Area of Science:
- Immunology
- Rheumatology
- Pulmonology
Context:
- Sarcoidosis pathogenesis involves Tumor Necrosis Factor-alpha (TNFα).
- TNFα blocking agents are used for refractory sarcoidosis.
- Limited data exist on anti-TNFα therapies in sarcoidosis.
Purpose:
- To review the efficacy of TNFα blocking agents in sarcoidosis.
- To investigate paradoxical sarcoidosis development during anti-TNFα therapy.
Summary:
- Infliximab improved extra-pulmonary sarcoidosis but not pulmonary disease in randomized trials.
- Etanercept showed no efficacy in ocular or pulmonary sarcoidosis.
- A literature review identified 28 cases of paradoxical sarcoidosis associated with anti-TNFα agents (etanercept, infliximab, adalimumab), suggesting a class effect.
Impact:
- Clinicians should be aware of the potential for anti-TNFα agents to induce sarcoidosis.
- Understanding cytokine balance shifts is crucial for managing treatment-induced sarcoidosis.
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