Tocilizumab in sarcoidosis patients failing steroid sparing therapies and anti-TNF agents

Sharp, Michelle; Donnelly, Seamas C; Möller, David R.

doi:10.1016/j.yrmex.2019.100004

Cited by 30 publications

(16 citation statements)

References 26 publications

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“…Additionally, depression has been associated with higher levels of pro-inflammatory cytokines, including tumour necrosis factor and interleukin-6,39 both of which contribute to the immunopathology of sarcoidosis. Interleukin-6 has been shown to be highly expressed in sarcoidosis-affected tissues40 and is described as a potential treatment target in sarcoidosis 41. Enhanced expression of interferon-gamma (IFNγ) remains the principal immunological characteristic of sarcoidosis 42.…”

Section: Discussionmentioning

confidence: 99%

Psychological burden associated with worse clinical outcomes in sarcoidosis

et al. 2019

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IntroductionSarcoidosis is a multisystem granulomatous inflammatory disorder. Sarcoidosis is associated with significant morbidity and rising healthcare utilisation. Patients with sarcoidosis report higher psychological symptoms than the general population. We evaluated the association between depressive and anxiety symptoms and clinical outcomes in patients with pulmonary sarcoidosis requiring treatment.MethodsAdult patients in the Johns Hopkins Sarcoidosis Clinic diagnosed with pulmonary sarcoidosis on treatment were eligible for enrollment. Questionnaires were administered to assess depressive and anxiety symptoms, healthcare utilisation and health-related quality of life (HRQoL).Results112 participants were enrolled (57% women, 53% African American, median age: 57 years). 34% of participants screened positive for mild and 20% for moderate–severe depressive symptoms. 25% of participants screened positive for mild and 12% for moderate–severe anxiety symptoms. Participants with moderate–severe psychological symptoms had a higher odds of an emergency department visit in the previous 6 months (8.87 for depressive symptoms and 13.05 for anxiety symptoms) and worse HRQoL compared with participants without psychological symptoms. Participants with moderate–severe depressive symptoms had lower diffusion capacity of the lungs for carbon monoxide % predicted compared with those without depressive symptoms. There was no association between elevated psychological symptoms and the odds of hospitalisation, forced vital capacity % predicted and forced expiratory volume in 1 second % predicted.ConclusionPsychological symptoms may be associated with worse clinical outcomes in sarcoidosis. Improving the recognition through clinic screening and referral for treatment of depression and anxiety in sarcoidosis may reduce acute healthcare utilisation and improve HRQoL.

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Section: Discussionmentioning

confidence: 99%

Psychological burden associated with worse clinical outcomes in sarcoidosis

et al. 2019

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“…Improvement with tocilizumab was reported in a case series of four patients with multi-systemic sarcoidosis that was refractory to conventional immunosuppression and anti-TNFα agents. 30 In this series, one patient with lupus pernio and sinopulmonary involvement received tocilizumab 4 mg/kg monthly, which resulted in longstanding cutaneous and pulmonary improvement. Interestingly, the development of sarcoidosis with tocilizumab is reported at least four times in the literature, though the mechanism is poorly understood.…”

Section: Sarcoidosis (Level IV Evidence)mentioning

confidence: 97%

Does tocilizumab have a role in dermatology? A review of clinical applications, its adverse side effects and practical considerations

Choong

Tan

2021

Dermatologic Therapy

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Tocilizumab is a humanized monoclonal antibody to the interleukin-6 (IL-6) receptor which was first approved for use in refractory rheumatoid arthritis almost a decade ago. Since then, its use has expanded to a number of rheumatological and inflammatory conditions. In dermatology, off-label use of tocilizumab has been reported to be efficacious in morphoea, systemic sclerosis, psoriasis, atopic dermatitis, vitiligo, graftversus-host disease, pyoderma gangrenosum, Behcet's disease, Schnitzler's syndrome, sarcoidosis, and cutaneous adverse reactions. That being said, the evidence demonstrating tocilizumab's efficacy in dermatology is predominantly low-level casebased evidence, and one must consider the potential for publication bias. In this review we will discuss the reported clinical applications of tocilizumab in dermatology, mechanisms of action, and the range of associated adverse effects (both cutaneous and non-cutaneous) that can occur. Additionally, we will discuss the role of tocilizumab in the management of COVID-19.

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“…Some of them are targeted to the recently highlighted mTOR, IL6, or JAK/STAT pathways. They might be recommended in severe active sarcoidosis resistant to the first three lines of treatment: rituximab [93]; repository corticotropin [94]; anti-IL6 like tocilizumab [95]; anti-JAK like tofacitinib or ruxolitinib [96,97]; and mTOR inhibitors like sirolimus [98].…”

Section: Fourth-line Therapymentioning

confidence: 99%

How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis

et al. 2021

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Extrapulmonary sarcoidosis occurs in 30-50% of cases of sarcoidosis, most often in association with pulmonary involvement, and virtually any organ can be involved. Its incidence depends according to the organs considered, clinical phenotype, and history of sarcoidosis, but also on epidemiological factors like age, sex, geographic ancestry, and socio-professional factors. The presentation, symptomatology, organ dysfunction, severity, and lethal risk vary from and to patient even at the level of the same organ. The presentation may be specific or not, and its occurrence is at variable times in the history of sarcoidosis from initial to delayed. There are

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Tocilizumab in sarcoidosis patients failing steroid sparing therapies and anti-TNF agents

Cited by 30 publications

References 26 publications

Psychological burden associated with worse clinical outcomes in sarcoidosis

Psychological burden associated with worse clinical outcomes in sarcoidosis

Does tocilizumab have a role in dermatology? A review of clinical applications, its adverse side effects and practical considerations

How to Tackle the Diagnosis and Treatment in the Diverse Scenarios of Extrapulmonary Sarcoidosis

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