Management of Clinical Cardiac Sarcoidosis Isolated to the Heart With Tumor Necrosis Factor-Alpha Inhibitors

Sarcoidosis, when clinically isolated to the heart, is characterized by a high burden of disease, diagnostic uncertainty, and treatment challenges. Tumor necrosis factor-alpha inhibitors (TNF-αi) are increasingly used to treat cardiac sarcoidosis (CS), however, hesitancy and limited guidance remain regarding the treatment of patients with isolated CS.

Here, we present 6 cases of clinically isolated CS treated with TNF-ai. We describe diagnostic testing, treatment history, and outcomes after initiation of TNF-ai.

There is hesitancy and lack of evidence in treating non-biopsy confirmed isolated CS with TNF-ai because of diagnostic uncertainty and often more advanced cardiomyopathy. We find that this treatment approach is generally well tolerated, with favorable outcomes. A shared decision-making approach should be included.

TNF-ai treatment can improve cardiac inflammation on fluorodeoxyglucose positron emission tomography and reduce corticosteroid exposure in sarcoidosis isolated to the heart.