Treatment of Erdheim-Chester disease from the perspective in 2026

With the discovery of new drugs, treatment of Erdheim-Chester disease (ECD) is gradually evolving and changing. The text provides an overview of effective drugs available in 2026 for patients with ECD. Treatment options: We consider it appropriate to divide treatment into treatment targeting the inflammatory reaction induced by ECD, and treatment targeting malignant histiocytes. To suppress the inflammatory reaction, high doses of glucocorticoids can be used, but only short-term. For long-term suppression of the inflammatory reaction, anakinra is most commonly used. In rare cases, a similar effect has been reported with canakinumab, as well as with sirolimus and anti-TNF drugs. Anakinra is used both alone and in combination with other drugs. ECD cells, like histiocytosis cells from Langerhans cells, are derived from a monocytic lineage, which similarly to the lymphocytic lineage, is very sensitive to cladribine (2-chloro-2'-deoxyadenosine). This drug is the most effective cytostatic agent for patients with ECD. In several smaller clinical studies, the benefit of treatment with interferon alfa has been described. Thus, interferon alfa, despite its side effects, represents one of the treatment options. In cases of severe ECD and the presence of the BRAFV600E mutation, two drugs are recommended - vemurafenib and dabrafenib. For patients with a severe course without the BRAFV600E mutation, MEK kinase inhibitors trametinib and cobimetinib are recommended. The literature contains conflicting conclusions in studies evaluating the dependence of the effectiveness of these drugs on the detection of mutations in the MAPK signaling pathway. Targeted therapy is associated with numerous side effects, as well as the risk of relapse after its discontinuation. If the administered drugs trigger an inflammatory response, anakinra is again used to suppress it.

Treatment of ECD always requires an assessment of the extent of the disease and degree of organ damage in order to choose the appropriate therapy.