Clinical and Imaging Response to Tumor Necrosis Factor Alpha Inhibitors in Treatment of Cardiac Sarcoidosis: A Multicenter Experience

Gilotra, Nisha A.; Wand, Alison L.; Pillarisetty, Anjani; Devraj, Mithun; Pavlovic, Noelle; Ahmed, Sara; Saad, Elie; Solnes, Lilja B.; García, Carlos; Okada, David R.; Constantinescu, Florina; Mohammed, Selma F.; Griffin, Jan M.; Kasper, Edward K.; Chen, Edward S.; Sheikh, Farooq H.

doi:10.1016/j.cardfail.2020.08.013

Cited by 37 publications

(25 citation statements)

References 33 publications

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“…In a prospective study, 38 patients with CaS were treated with TNFA (30 infliximab; 8 adalimumab). The use of TNFA was associated with reduced CS dose at 6and 12-months as well as a reduced maximum FDG uptake, however there was no change in LVEF [40]. Favorable responses have been cited with rituximab, but data are limited to a few cases.…”

Section: Treatment Of Casmentioning

confidence: 99%

Extrapulmonary sarcoidosis with a focus on cardiac, nervous system, and ocular involvement

Belperio¹,

Shaikh²,

Abtin

et al. 2021

eClinicalMedicine

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Sarcoidosis is a poorly understood granulomatous disease that involves the lungs and/or intrathoracic lymph nodes in more than 90% of cases. Although pulmonary sarcoidosis is the leading cause of mortality in this disease, this review focuses on three sites of extrapulmonary involvement (heart, nervous system, and eyes), since involvement of any of these sites can be catastrophic, leading to death, debilitation, or blindness. Patients with cardiac, ocular and neurosarcoidosis necessitate a multidisciplinary approach with careful and long-term follow-up. Prompt diagnosis with imaging and/or biopsy and treatment is required to avoid irreversible damage. Corticosteroids are the mainstay of therapy and are often associated with rapid and durable remissions. Immunosuppressive or biologic agents are reserved for patients failing or experiencing side effects from steroids. Managing sarcoidosis requires vigilance, judgement, and awareness of the vagaries of this fascinating disease.

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Section: Treatment Of Casmentioning

confidence: 99%

Extrapulmonary sarcoidosis with a focus on cardiac, nervous system, and ocular involvement

Belperio¹,

Shaikh²,

Abtin

et al. 2021

eClinicalMedicine

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“…TNFα antagonists permitted a decrease in mean dose of CT (23-4 mg/day) at 6 months and complete discontinuation of CT after a mean of 9 months of treatment with TNFα antagonists. In 2020, Gilotra et al (26) reported 38 patients with CS treated with TNFα antagonists (infliximab or adalimumab), with a significant decrease in CT dose within 6 or 12 months of treatment, and CT discontinuation in 10 out of 38 patients. The increase in LVEF after treatment was not significant (45 before vs. 47% after treatment), and four (11%) patients suffered from infection as an adverse effect of IT.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging endpoints were chosen in three studies (23,25,27) with good outcomes on disease activity on myocardial FDG-PET uptake. Data on CT discontinuation after TNFα antagonists' initiation were scarce, but studies found significant decrease in CT dose in the follow-up under TNFα antagonists (24,26). Data on risk of worsening heart failure under TNFα antagonists were reassuring in two studies, with a global LVEF stability before and after treatment initiation (26) and significant LVEF increase from 45 to 55% (27).…”

Section: Discussionmentioning

confidence: 99%

“…Data on CT discontinuation after TNFα antagonists' initiation were scarce, but studies found significant decrease in CT dose in the follow-up under TNFα antagonists (24,26). Data on risk of worsening heart failure under TNFα antagonists were reassuring in two studies, with a global LVEF stability before and after treatment initiation (26) and significant LVEF increase from 45 to 55% (27). Nonetheless, a specific attention toward worsening heart failure under TNFα antagonists should be mentioned, as four patients experienced worsening in LVEF in Gilotra et al cohort (26), especially in patients with severely impaired pre-treatment LVEF (20-35%).…”

Section: Discussionmentioning

confidence: 99%

“…In severe or refractory disease, TNFα antagonists are effective in ocular (13), neurological (14), osseous (15), and pulmonary (16,17), sarcoidosis. In CS, a few cases reports (18)(19)(20)(21)(22) and five cohort studies (23)(24)(25)(26)(27) have shown benefits of CT with or without IT in patients with severe and/or refractory cardiac involvement. Although there has been no randomized controlled study, some articles and expert opinions have suggested that TNFα antagonists for severe or refractory CS might be an option in case of CT or IT failure (28-30).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: TNFα Antagonists Are an Effective Therapy in Cardiac Sarcoidosis

Stievenart¹,

Guenno²,

Ruivard³

et al. 2021

Front. Cardiovasc. Med.

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Introduction: Cardiac sarcoidosis (CS) is a life-threatening disease in which clear recommendations are lacking. We report a case series of CS successfully treated by tumor necrosis factor (TNF)α antagonists.Methods: We conducted a single-center retrospective study of our patients with CS treated by TNFα antagonists.Results: Four cases (4/84, 4.7%) were found in our database. Mean age was 40 years (range 34–53 years), and all were Caucasian men. Mean follow-up was 54.75 months (range 25–115 months). All patients received corticosteroid therapy (CT) and immunosuppressive therapy (IT). TNFα antagonists (infliximab or adalimumab) were started after the first or second CS relapse under CT and IT. One patient experienced relapse under TNFα antagonists (isolated decreased left ventricular ejection) and responded to a shorter interval of TNFα antagonist infusion. CT was discontinued in three patients treated with TNFα antagonists without relapse or major cardiac events during follow-up. No serious adverse event occurred in our case series, possibly due to dose sparing and frequent arrest of CT.Conclusion: TNFα antagonists were effective in refractory and/or relapsing CS treated by corticosteroids and/or immunosuppressive agents, without serious adverse events, and should be considered earlier in CS treatment scheme.

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