Controversies in the Treatment of Cardiac Sarcoidosis

Main Article Content

Ogugua Ndili Obi
Elyse E. Lower
Robert P. Baughman


cardiac sarcoidosis,, corticosteroids,, immunosuppressive therapy, anti-TNF agents in cardiac sarcoidosis


There are many challenging aspects of the management of cardiac sarcoidosis (CS) with corticosteroids and other immunosuppressive therapy ( IST). First, it is not always clear who will benefit from therapy or when to initiate treatment. Secondly, there are no randomized controlled trials or large prospective studies to guide what medications to use, at what doses, for how long.

The European Respiratory Society (ERS) clinical practice guidelines on the treatment of sarcoidosis makes a strong recommendation for the use of immunosuppressive therapy in CS patients with functional cardiac abnormalities, including heart blocks, dysrhythmias, or cardiomyopathy where patients are considered at-risk of adverse outcomes.

Corticosteroids are the first line immunosuppressive therapy in CS however, early initiation of second-line steroid sparing medications has been advocated and there is data to suggest that concomitant initiation of therapy may be more beneficial. The use of anti-tumour necrosis factor (anti-TNF) antagonists (including infliximab and adalimumab) considered beneficial third-line anti-sarcoidosis treatment agents in other severe refractory manifestations of disease remains controversial.

Abstract 920 | PDF Downloads 584


1. Rahaghi FF, Baughman RP, Saketkoo LA, Sweiss NJ, Barney JB, Birring SS, et al. Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis. Eur Respir Rev. 2020;29(155). Epub 2020/03/20. doi: 10.1183/16000617.0146-2019. PubMed PMID: 32198218.
2. Baughman RP, Valeyre D, Korsten P, Mathioudakis AG, Wuyts WA, Wells A, et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J. 2021;58(6). Epub 2021/06/19. doi: 10.1183/13993003.04079-2020. PubMed PMID: 34140301.
3. Ballul T, Borie R, Crestani B, Daugas E, Descamps V, Dieude P, et al. Treatment of cardiac sarcoidosis: A comparative study of steroids and steroids plus immunosuppressive drugs. Int J Cardiol. 2019;276:208-11. Epub 2018/11/30. doi: 10.1016/j.ijcard.2018.11.131. PubMed PMID: 30527995.
4. Stievenart J, Le Guenno G, Ruivard M, Rieu V, Andre M, Grobost V. Cardiac sarcoidosis: systematic review of literature on corticosteroid and immunosuppressive therapies. Eur Respir J. 2021. Epub 2021/09/18. doi: 10.1183/13993003.00449-2021. PubMed PMID: 34531273.
5. Birnie D, Beanlands RSB, Nery P, Aaron SD, Culver DA, DeKemp RA, et al. Cardiac Sarcoidosis multi-center randomized controlled trial (CHASM CS- RCT). Am Heart J. 2020;220:246-52. Epub 2019/10/20. doi: 10.1016/j.ahj.2019.10.003. PubMed PMID: 31911261; PubMed Central PMCID: PMC7367280.
6. Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm. 2014;11(7):1305-23. Epub 2014/05/14. doi: 10.1016/j.hrthm.2014.03.043. PubMed PMID: 24819193.
7. Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M, et al. JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis - Digest Version. Circ J. 2019;83(11):2329-88. Epub 2019/10/09. doi: 10.1253/circj.CJ-19-0508. PubMed PMID: 31597819.
8. Fussner LA, Karlstedt E, Hodge DO, Fine NM, Kalra S, Carmona EM, et al. Management and outcomes of cardiac sarcoidosis: a 20-year experience in two tertiary care centres. Eur J Heart Fail. 2018;20(12):1713-20. Epub 2018/10/31. doi: 10.1002/ejhf.1319. PubMed PMID: 30378224.
9. Zhou Y, Lower EE, Li HP, Costea A, Attari M, Baughman RP. Cardiac Sarcoidosis: The Impact of Age and Implanted Devices on Survival. Chest. 2017;151(1):139-48. Epub 2016/09/08. doi: 10.1016/j.chest.2016.08.1457. PubMed PMID: 27614001.
10. West SG. Current management of sarcoidosis I: pulmonary, cardiac, and neurologic manifestations. Curr Opin Rheumatol. 2018;30(3):243-8. doi: 10.1097/BOR.0000000000000489. PubMed PMID: 29389828.
11. Bakker ALM, Mathijssen H, Azzahhafi J, Swaans MJ, Veltkamp M, Keijsers RGM, et al. Effectiveness and safety of infliximab in cardiac Sarcoidosis. Int J Cardiol. 2021;330:179-85. Epub 2021/02/15. doi: 10.1016/j.ijcard.2021.02.022. PubMed PMID: 33582196.
12. Harper LJ, McCarthy M, Ribeiro Neto ML, Hachamovitch R, Pearson K, Bonanno B, et al. Infliximab for Refractory Cardiac Sarcoidosis. Am J Cardiol. 2019;124(10):1630-5. Epub 2019/08/23. doi: 10.1016/j.amjcard.2019.07.067. PubMed PMID: 31500815.
13. Andrews JC, Schunemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Coello PA, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength. J Clin Epidemiol. 2013;66(7):726-35. Epub 2013/04/11. doi: 10.1016/j.jclinepi.2013.02.003. PubMed PMID: 23570745.
14. Silverman KJ, Hutchins GM, Bulkley BH. Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation. 1978;58(6):1204-11. doi: 10.1161/01.cir.58.6.1204. PubMed PMID: 709777.
15. Iwai K, Sekiguti M, Hosoda Y, DeRemee RA, Tazelaar HD, Sharma OP, et al. Racial difference in cardiac sarcoidosis incidence observed at autopsy. Sarcoidosis. 1994;11(1):26-31. PubMed PMID: 8036339.
16. Hu X, Carmona EM, Yi ES, Pellikka PA, Ryu J. Causes of death in patients with chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016;33(3):275-80. PubMed PMID: 27758994.
17. Sekiguchi M, Hiroe M, Take M, Hirosawa K. Clinical and histopathological profile of sarcoidosis of the heart and acute idiopathic myocarditis. Concepts through a study employing endomyocardial biopsy. II. Myocarditis. Jpn Circ J. 1980;44(4):264-73. PubMed PMID: 6154812.
18. Takaya Y, Kusano KF, Nakamura K, Ito H. Outcomes in patients with high-degree atrioventricular block as the initial manifestation of cardiac sarcoidosis. Am J Cardiol. 2015;115(4):505-9. Epub 2014/11/29. doi: 10.1016/j.amjcard.2014.11.028. PubMed PMID: 25529542.
19. Ekström K, Lehtonen J, Nordenswan HK, Mäyränpää MI, Räisänen-Sokolowski A, Kandolin R, et al. Sudden death in cardiac sarcoidosis: an analysis of nationwide clinical and cause-of-death registries. Eur Heart J. 2019. Epub 2019/06/23. doi: 10.1093/eurheartj/ehz428. PubMed PMID: 31230070.
20. Nordenswan HK, Lehtonen J, Ekström K, Kandolin R, Simonen P, Mäyränpää M, et al. Outcome of Cardiac Sarcoidosis Presenting With High-Grade Atrioventricular Block. Circ Arrhythm Electrophysiol. 2018;11(8):e006145. doi: 10.1161/CIRCEP.117.006145. PubMed PMID: 30354309.
21. Cacoub P, Chapelon-Abric C, Resche-Rigon M, Saadoun D, Desbois AC, Biard L. Cardiac sarcoidosis: A long term follow up study. PLoS One. 2020;15(9):e0238391. Epub 2020/09/19. doi: 10.1371/journal.pone.0238391. PubMed PMID: 32946452; PubMed Central PMCID: PMC7500618.
22. Kandolin R, Lehtonen J, Kupari M. Cardiac sarcoidosis and giant cell myocarditis as causes of atrioventricular block in young and middle-aged adults. Circ Arrhythm Electrophysiol. 2011;4(3):303-9. Epub 2011/03/22. doi: 10.1161/CIRCEP.110.959254. PubMed PMID: 21427276.
23. Yazaki Y, Isobe M, Hiroe M, Morimoto S, Hiramitsu S, Nakano T, et al. Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol. 2001;88(9):1006-10. PubMed PMID: 11703997.
24. Chapelon-Abric C, de Zuttere D, Duhaut P, Veyssier P, Wechsler B, Huong DL, et al. Cardiac sarcoidosis: a retrospective study of 41 cases. Medicine (Baltimore). 2004;83(6):315-34. doi: 10.1097/ PubMed PMID: 15525844.
25. Rosenthal DG, Cheng RK, Petek BJ, Masri SC, Mikacenic C, Raghu G, et al. Risk of Adverse Cardiovascular Events in Cardiac Sarcoidosis Independent of Left Ventricular Function. Am J Cardiol. 2020;127:142-8. Epub 2020/04/23. doi: 10.1016/j.amjcard.2020.04.025. PubMed PMID: 32402485.
26. Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol. 2014;63(4):329-36. Epub 2013/10/16. doi: 10.1016/j.jacc.2013.09.022. PubMed PMID: 24140661; PubMed Central PMCID: PMC3955730.
27. Flores RJ, Flaherty KR, Jin Z, Bokhari S. The prognostic value of quantitating and localizing F-18 FDG uptake in cardiac sarcoidosis. J Nucl Cardiol. 2018. Epub 2018/11/12. doi: 10.1007/s12350-018-01504-y. PubMed PMID: 30421379.
28. Sperry BW, Tamarappoo BK, Oldan JD, Javed O, Culver DA, Brunken R, et al. Prognostic Impact of Extent, Severity, and Heterogeneity of Abnormalities on. JACC Cardiovasc Imaging. 2018;11(2 Pt 2):336-45. Epub 2017/08/16. doi: 10.1016/j.jcmg.2017.04.020. PubMed PMID: 28823747.
29. Ise T, Hasegawa T, Morita Y, Yamada N, Funada A, Takahama H, et al. Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis. Heart. 2014;100(15):1165-72. Epub 2014/05/14. doi: 10.1136/heartjnl-2013-305187. PubMed PMID: 24829369.
30. Hulten E, Agarwal V, Cahill M, Cole G, Vita T, Parrish S, et al. Presence of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Among Patients With Suspected Cardiac Sarcoidosis Is Associated With Adverse Cardiovascular Prognosis: A Systematic Review and Meta-Analysis. Circ Cardiovasc Imaging. 2016;9(9):e005001. doi: 10.1161/CIRCIMAGING.116.005001. PubMed PMID: 27621357; PubMed Central PMCID: PMC5449111.
31. Kandolin R, Lehtonen J, Airaksinen J, Vihinen T, Miettinen H, Ylitalo K, et al. Cardiac sarcoidosis: epidemiology, characteristics, and outcome over 25 years in a nationwide study. Circulation. 2015;131(7):624-32. Epub 2014/12/19. doi: 10.1161/CIRCULATIONAHA.114.011522. PubMed PMID: 25527698.
32. Joyce E, Ninaber MK, Katsanos S, Debonnaire P, Kamperidis V, Bax JJ, et al. Subclinical left ventricular dysfunction by echocardiographic speckle-tracking strain analysis relates to outcome in sarcoidosis. Eur J Heart Fail. 2015;17(1):51-62. Epub 2014/11/29. doi: 10.1002/ejhf.205. PubMed PMID: 25431267.
33. Kandolin R, Lehtonen J, Airaksinen J, Vihinen T, Miettinen H, Kaikkonen K, et al. Usefulness of Cardiac Troponins as Markers of Early Treatment Response in Cardiac Sarcoidosis. Am J Cardiol. 2015;116(6):960-4. Epub 2015/06/26. doi: 10.1016/j.amjcard.2015.06.021. PubMed PMID: 26209113.
34. Yoshida Y, Morimoto S, Hiramitsu S, Tsuboi N, Hirayama H, Itoh T. Incidence of cardiac sarcoidosis in Japanese patients with high-degree atrioventricular block. Am Heart J. 1997;134(3):382-6. PubMed PMID: 9327691.
35. Fawcett FJ, Goldberg MJ. Heart block resulting from myocardial sarcoidosis. Br Heart J. 1974;36(2):220-3. doi: 10.1136/hrt.36.2.220. PubMed PMID: 4818154; PubMed Central PMCID: PMC458821.
36. Roberts WC, McAllister HA, Ferrans VJ. Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med. 1977;63(1):86-108. doi: 10.1016/0002-9343(77)90121-8. PubMed PMID: 327806.
37. Nery PB, Beanlands RS, Nair GM, Green M, Yang J, McArdle BA, et al. Atrioventricular block as the initial manifestation of cardiac sarcoidosis in middle-aged adults. J Cardiovasc Electrophysiol. 2014;25(8):875-81. Epub 2014/05/02. doi: 10.1111/jce.12401. PubMed PMID: 24602015.
38. Fazelpour S, Sadek MM, Nery PB, Beanlands RS, Tzemos N, Toma M, et al. Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review. J Am Heart Assoc. 2021;10(17):e021183. Epub 2021/09/03. doi: 10.1161/JAHA.121.021183. PubMed PMID: 34472360.
39. Sadek MM, Yung D, Birnie DH, Beanlands RS, Nery PB. Corticosteroid therapy for cardiac sarcoidosis: a systematic review. Can J Cardiol. 2013;29(9):1034-41. Epub 2013/04/24. doi: 10.1016/j.cjca.2013.02.004. PubMed PMID: 23623644.
40. Chapelon-Abric C, Sene D, Saadoun D, Cluzel P, Vignaux O, Costedoat-Chalumeau N, et al. Cardiac sarcoidosis: Diagnosis, therapeutic management and prognostic factors. Arch Cardiovasc Dis. 2017;110(8-9):456-65. Epub 2017/06/02. doi: 10.1016/j.acvd.2016.12.014. PubMed PMID: 28566197.
41. Banba K, Kusano KF, Nakamura K, Morita H, Ogawa A, Ohtsuka F, et al. Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis. Heart Rhythm. 2007;4(10):1292-9. Epub 2007/06/16. doi: 10.1016/j.hrthm.2007.06.006. PubMed PMID: 17905334.
42. Yodogawa K, Seino Y, Shiomura R, Takahashi K, Tsuboi I, Uetake S, et al. Recovery of atrioventricular block following steroid therapy in patients with cardiac sarcoidosis. J Cardiol. 2013;62(5):320-5. Epub 2013/09/06. doi: 10.1016/j.jjcc.2013.07.007. PubMed PMID: 24016620.
43. Orii M, Tanimoto T, Ota S, Takagi H, Tanaka R, Fujiwara J, et al. Diagnostic accuracy of cardiac magnetic resonance imaging for cardiac sarcoidosis in complete heart block patients implanted with magnetic resonance-conditional pacemaker. J Cardiol. 2020;76(2):191-7. Epub 2020/03/14. doi: 10.1016/j.jjcc.2020.02.014. PubMed PMID: 32184028.
44. Chiu CZ, Nakatani S, Zhang G, Tachibana T, Ohmori F, Yamagishi M, et al. Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol. 2005;95(1):143-6. Epub 2004/12/28. doi: 10.1016/j.amjcard.2004.08.083. PubMed PMID: 15619415.
45. Kaida T, Inomata T, Minami Y, Yazaki M, Fujita T, Iida Y, et al. Importance of Early Diagnosis of Cardiac Sarcoidosis in Patients with Complete Atrioventricular Block. Int Heart J. 2018;59(4):772-8. Epub 2018/05/23. doi: 10.1536/ihj.17-492. PubMed PMID: 29794391.
46. Padala SK, Peaslee S, Sidhu MS, Steckman DA, Judson MA. Impact of early initiation of corticosteroid therapy on cardiac function and rhythm in patients with cardiac sarcoidosis. Int J Cardiol. 2017;227:565-70. Epub 2016/11/02. doi: 10.1016/j.ijcard.2016.10.101. PubMed PMID: 27836297.
47. Kudoh H, Fujiwara S, Shiotani H, Kawai H, Hirata K. Myocardial washout of 99mTc-tetrofosmin and response to steroid therapy in patients with cardiac sarcoidosis. Ann Nucl Med. 2010;24(5):379-85. Epub 2010/05/08. doi: 10.1007/s12149-010-0376-8. PubMed PMID: 20454875.
48. Nagai T, Nagano N, Sugano Y, Asaumi Y, Aiba T, Kanzaki H, et al. Effect of Corticosteroid Therapy on Long-Term Clinical Outcome and Left Ventricular Function in Patients With Cardiac Sarcoidosis. Circ J. 2015;79(7):1593-600. Epub 2015/04/16. doi: 10.1253/circj.CJ-14-1275. PubMed PMID: 25877828.
49. Nagai S, Yokomatsu T, Tanizawa K, Ikezoe K, Handa T, Ito Y, et al. Treatment with methotrexate and low-dose corticosteroids in sarcoidosis patients with cardiac lesions. Intern Med. 2014;53(5):427-33. doi: 10.2169/internalmedicine.53.0794. PubMed PMID: 24583430.
50. Takaya Y, Kusano KF, Nakamura K, Kaji M, Shinya T, Kanazawa S, et al. Reduction of myocardial inflammation with steroid is not necessarily associated with improvement in left ventricular function in patients with cardiac sarcoidosis: predictors of functional improvement. Int J Cardiol. 2014;176(2):522-5. Epub 2014/07/12. doi: 10.1016/j.ijcard.2014.07.042. PubMed PMID: 25062558.
51. Gilotra NA, Wand AL, Pillarisetty A, Devraj M, Pavlovic N, Ahmed S, et al. Clinical and Imaging Response to Tumor Necrosis Factor Alpha Inhibitors in Treatment of Cardiac Sarcoidosis: A Multicenter Experience. J Card Fail. 2021;27(1):83-91. Epub 2020/09/06. doi: 10.1016/j.cardfail.2020.08.013. PubMed PMID: 32889044; PubMed Central PMCID: PMC8350936.
52. Medor MC, Spence S, Nery PB, Beanlands R, Promislow S, Juneau D, et al. Treatment with corticosteroids is associated with an increase in ventricular arrhythmia burden in patients with clinically manifest cardiac sarcoidosis: Insights from implantable cardioverter-defibrillator diagnostics. J Cardiovasc Electrophysiol. 2020. Epub 2020/07/26. doi: 10.1111/jce.14689. PubMed PMID: 32713090.
53. Yodogawa K, Seino Y, Ohara T, Takayama H, Katoh T, Mizuno K. Effect of corticosteroid therapy on ventricular arrhythmias in patients with cardiac sarcoidosis. Ann Noninvasive Electrocardiol. 2011;16(2):140-7. doi: 10.1111/j.1542-474X.2011.00418.x. PubMed PMID: 21496164.
54. Jefic D, Joel B, Good E, Morady F, Rosman H, Knight B, et al. Role of radiofrequency catheter ablation of ventricular tachycardia in cardiac sarcoidosis: report from a multicenter registry. Heart Rhythm. 2009;6(2):189-95. Epub 2008/10/30. doi: 10.1016/j.hrthm.2008.10.039. PubMed PMID: 19187909.
55. Futamatsu H, Suzuki J, Adachi S, Okada H, Otomo K, Ohara T, et al. Utility of gallium-67 scintigraphy for evaluation of cardiac sarcoidosis with ventricular tachycardia. Int J Cardiovasc Imaging. 2006;22(3-4):443-8. Epub 2006/03/14. doi: 10.1007/s10554-005-9043-x. PubMed PMID: 16763884.
56. Yalagudri S, Zin Thu N, Devidutta S, Saggu D, Thachil A, Chennapragada S, et al. Tailored approach for management of ventricular tachycardia in cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2017;28(8):893-902. doi: 10.1111/jce.13228. PubMed PMID: 28429512.
57. Naruse Y, Sekiguchi Y, Nogami A, Okada H, Yamauchi Y, Machino T, et al. Systematic treatment approach to ventricular tachycardia in cardiac sarcoidosis. Circ Arrhythm Electrophysiol. 2014;7(3):407-13. Epub 2014/05/16. doi: 10.1161/CIRCEP.113.000734. PubMed PMID: 24837644.
58. Winters SL, Cohen M, Greenberg S, Stein B, Curwin J, Pe E, et al. Sustained ventricular tachycardia associated with sarcoidosis: assessment of the underlying cardiac anatomy and the prospective utility of programmed ventricular stimulation, drug therapy and an implantable antitachycardia device. J Am Coll Cardiol. 1991;18(4):937-43. PubMed PMID: 1894867.
59. Stees CS, Khoo MS, Lowery CM, Sauer WH. Ventricular tachycardia storm successfully treated with immunosuppression and catheter ablation in a patient with cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2011;22(2):210-3. doi: 10.1111/j.1540-8167.2010.01826.x. PubMed PMID: 20561106.
60. Segawa M, Fukuda K, Nakano M, Kondo M, Satake H, Hirano M, et al. Time Course and Factors Correlating With Ventricular Tachyarrhythmias After Introduction of Steroid Therapy in Cardiac Sarcoidosis. Circ Arrhythm Electrophysiol. 2016;9(6). doi: 10.1161/CIRCEP.115.003353. PubMed PMID: 27301264.
61. Muser D, Santangeli P, Castro SA, Liang JJ, Enriquez A, Werner TJ, et al. Prognostic role of serial quantitative evaluation of. Eur J Nucl Med Mol Imaging. 2018;45(8):1394-404. Epub 2018/04/02. doi: 10.1007/s00259-018-4001-8. PubMed PMID: 29610956.
62. Kumar S, Barbhaiya C, Nagashima K, Choi EK, Epstein LM, John RM, et al. Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation. Circ Arrhythm Electrophysiol. 2015;8(1):87-93. Epub 2014/12/19. doi: 10.1161/CIRCEP.114.002145. PubMed PMID: 25527825.
63. Koplan BA, Soejima K, Baughman K, Epstein LM, Stevenson WG. Refractory ventricular tachycardia secondary to cardiac sarcoid: electrophysiologic characteristics, mapping, and ablation. Heart Rhythm. 2006;3(8):924-9. Epub 2006/03/30. doi: 10.1016/j.hrthm.2006.03.031. PubMed PMID: 16876741.
64. Griffin JM, Chasler J, Wand AL, Okada DR, Smith JN, Saad E, et al. Management of Cardiac Sarcoidosis Using Mycophenolate Mofetil as a Steroid-Sparing Agent. J Card Fail. 2021;27(12):1348-58. Epub 2021/06/25. doi: 10.1016/j.cardfail.2021.06.010. PubMed PMID: 34166800.
65. Sahoo DH, Bandyopadhyay D, Xu M, Pearson K, Parambil JG, Lazar CA, et al. Effectiveness and safety of leflunomide for pulmonary and extrapulmonary sarcoidosis. Eur Respir J. 2011;38(5):1145-50. Epub 2011/05/14. doi: 10.1183/09031936.00195010. PubMed PMID: 21565914.
66. Baughman RP, Lower EE. Leflunomide for chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2004;21(1):43-8. PubMed PMID: 15127974.
67. Majithia V, Sanders S, Harisdangkul V, Wilson JG. Successful treatment of sarcoidosis with leflunomide. Rheumatology (Oxford). 2003;42(5):700-2. doi: 10.1093/rheumatology/keg156. PubMed PMID: 12709556.
68. Fussner L, Karlstedt E, Fine N, Kalra S, Carmona E, Utz J, et al. Multicenter Experience With Mycophenolate Mofetil in Cardiac Sarcoidosis. CHEST. 2016;150(4):512A. doi:
69. Demeter SL. Myocardial sarcoidosis unresponsive to steroids. Treatment with cyclophosphamide. Chest. 1988;94(1):202-3. Epub 1988/07/01. doi: 10.1378/chest.94.1.202. PubMed PMID: 3383636.
70. Gallegos C, Oikonomou EK, Grimshaw A, Gulati M, Young BD, Miller EJ. Non-steroidal treatment of cardiac sarcoidosis: A systematic review. Int J Cardiol Heart Vasc. 2021;34:100782. Epub 2021/05/18. doi: 10.1016/j.ijcha.2021.100782. PubMed PMID: 33997256; PubMed Central PMCID: PMC8105294.
71. Ribeiro Neto ML, Jellis CL, Joyce E, Callahan TD, Hachamovitch R, Culver DA. Update in Cardiac Sarcoidosis. Ann Am Thorac Soc. 2019;16(11):1341-50. doi: 10.1513/AnnalsATS.201902-119CME. PubMed PMID: 31322914.
72. Nagai S, Yokomatsu T, Tanizawa K, Ikezoe K, Handa T, Ito Y, et al. Treatment with methotrexate and low-dose corticosteroids in sarcoidosis patients with cardiac lesions. Intern Med. 2014;53(23):2761. Epub 2014/12/03. doi: 10.2169/internalmedicine.53.3120. PubMed PMID: 25447669.
73. Baughman RP, Winget DB, Lower EE. Methotrexate is steroid sparing in acute sarcoidosis: results of a double blind, randomized trial. Sarcoidosis Vasc Diffuse Lung Dis. 2000;17(1):60-6. PubMed PMID: 10746262.
74. Cremers JP, Drent M, Bast A, Shigemitsu H, Baughman RP, Valeyre D, et al. Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide. Curr Opin Pulm Med. 2013;19(5):545-61. doi: 10.1097/MCP.0b013e3283642a7a. PubMed PMID: 23880702.
75. Lower EE, Baughman RP. The use of low dose methotrexate in refractory sarcoidosis. Am J Med Sci. 1990;299(3):153-7. PubMed PMID: 2316559.
76. Gerke AK. Treatment of Sarcoidosis: A Multidisciplinary Approach. Front Immunol. 2020;11:545413. Epub 2020/12/18. doi: 10.3389/fimmu.2020.545413. PubMed PMID: 33329511; PubMed Central PMCID: PMC7732561.
77. Montesinos MC, Desai A, Delano D, Chen JF, Fink JS, Jacobson MA, et al. Adenosine A2A or A3 receptors are required for inhibition of inflammation by methotrexate and its analog MX-68. Arthritis Rheum. 2003;48(1):240-7. Epub 2003/01/16. doi: 10.1002/art.10712. PubMed PMID: 12528125.
78. Cronstein BN, Naime D, Ostad E. The antiinflammatory effects of methotrexate are mediated by adenosine. Adv Exp Med Biol. 1994;370:411-6. Epub 1994/01/01. doi: 10.1007/978-1-4615-2584-4_89. PubMed PMID: 7660940.
79. Montesinos MC, Takedachi M, Thompson LF, Wilder TF, Fernandez P, Cronstein BN. The antiinflammatory mechanism of methotrexate depends on extracellular conversion of adenine nucleotides to adenosine by ecto-5'-nucleotidase: findings in a study of ecto-5'-nucleotidase gene-deficient mice. Arthritis Rheum. 2007;56(5):1440-5. Epub 2007/05/01. doi: 10.1002/art.22643. PubMed PMID: 17469101.
80. Gerards AH, de Lathouder S, de Groot ER, Dijkmans BA, Aarden LA. Inhibition of cytokine production by methotrexate. Studies in healthy volunteers and patients with rheumatoid arthritis. Rheumatology (Oxford). 2003;42(10):1189-96. Epub 2003/06/05. doi: 10.1093/rheumatology/keg323. PubMed PMID: 12777636.
81. Baughman RP. Methotrexate for sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 1998;15(2):147-9. PubMed PMID: 9789892.
82. Vorselaars AD, Cremers JP, Grutters JC, Drent M. Cytotoxic agents in sarcoidosis: which one should we choose? Curr Opin Pulm Med. 2014;20(5):479-87. Epub 2014/07/22. doi: 10.1097/MCP.0000000000000078. PubMed PMID: 25046427.
83. Lewis SJ, Ainslie GM, Bateman ED. Efficacy of azathioprine as second-line treatment in pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 1999;16(1):87-92. PubMed PMID: 10207946.
84. Muller-Quernheim J, Kienast K, Held M, Pfeifer S, Costabel U. Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen. Eur Respir J. 1999;14(5):1117-22. PubMed PMID: 10596700.
85. Vorselaars ADM, Wuyts WA, Vorselaars VMM, Zanen P, Deneer VHM, Veltkamp M, et al. Methotrexate vs azathioprine in second-line therapy of sarcoidosis. Chest. 2013;144(3):805-12. doi: 10.1378/chest.12-1728. PubMed PMID: 23538719.
86. Rossides M, Kullberg S, Di Giuseppe D, Eklund A, Grunewald J, Askling J, et al. Infection risk in sarcoidosis patients treated with methotrexate compared to azathioprine: A retrospective 'target trial' emulated with Swedish real-world data. Respirology. 2021;26(5):452-60. Epub 2021/01/06. doi: 10.1111/resp.14001. PubMed PMID: 33398914.
87. Trivieri MG, Spagnolo P, Birnie D, Liu P, Drake W, Kovacic JC, et al. Challenges in Cardiac and Pulmonary Sarcoidosis: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;76(16):1878-901. Epub 2020/10/17. doi: 10.1016/j.jacc.2020.08.042. PubMed PMID: 33059834; PubMed Central PMCID: PMC7808240.
88. Pavelcova K, Hanova P, Ciferska H, Hasikova L, Stiburkova B. The Examination of a TPMT Gene Before Administration of Azathioprine in Rheumatology Practice and Identification of a Novel Variant p.W29R. J Clin Rheumatol. 2021. Epub 2021/12/07. doi: 10.1097/RHU.0000000000001727. PubMed PMID: 34870401.
89. Jiyad Z, Olsen CM, Burke MT, Isbel NM, Green AC. Azathioprine and Risk of Skin Cancer in Organ Transplant Recipients: Systematic Review and Meta-Analysis. Am J Transplant. 2016;16(12):3490-503. Epub 2016/05/11. doi: 10.1111/ajt.13863. PubMed PMID: 27163483.
90. Pasternak B, Svanstrom H, Schmiegelow K, Jess T, Hviid A. Use of azathioprine and the risk of cancer in inflammatory bowel disease. Am J Epidemiol. 2013;177(11):1296-305. Epub 2013/03/22. doi: 10.1093/aje/kws375. PubMed PMID: 23514635.
91. Silman AJ, Petrie J, Hazleman B, Evans SJ. Lymphoproliferative cancer and other malignancy in patients with rheumatoid arthritis treated with azathioprine: a 20 year follow up study. Ann Rheum Dis. 1988;47(12):988-92. Epub 1988/12/01. doi: 10.1136/ard.47.12.988. PubMed PMID: 3207388; PubMed Central PMCID: PMC1003651.
92. Zhang Z, Wang M, Xu L, Jiang B, Jin T, Shi T, et al. Cancer occurrence following azathioprine treatment in myasthenia gravis patients: A systematic review and meta-analysis. J Clin Neurosci. 2021;88:70-4. Epub 2021/05/17. doi: 10.1016/j.jocn.2021.03.015. PubMed PMID: 33992207.
93. Allison AC. Mechanisms of action of mycophenolate mofetil. Lupus. 2005;14 Suppl 1:s2-8. Epub 2005/04/05. doi: 10.1191/0961203305lu2109oa. PubMed PMID: 15803924.
94. Yashima Y, Ohgane T. [Pharmacological profiles of mycophenolate mofetil (CellCept), a new immunosuppressive agent]. Nihon Yakurigaku Zasshi. 2001;117(2):131-7. Epub 2001/03/10. doi: 10.1254/fpj.117.131. PubMed PMID: 11233304.
95. Allison AC, Eugui EM. Mycophenolate mofetil and its mechanisms of action. Immunopharmacology. 2000;47(2-3):85-118. Epub 2000/07/06. doi: 10.1016/s0162-3109(00)00188-0. PubMed PMID: 10878285.
96. Godziszewska S, Widuchowska M, Kopeć-Mędrek M, Kucharz EJ. Coexistence of systemic sclerosis and sarcoidosis. Wiad Lek. 2016;69(4):693-4. PubMed PMID: 27941212.
97. Kikuchi N, Nunoda S, Serizawa N, Suzuki A, Suzuki T, Fukushima K, et al. Combination therapy with corticosteroid and mycophenolate mofetil in a case of refractory cardiac sarcoidosis. J Cardiol Cases. 2016;13(4):125-8. Epub 2016/03/06. doi: 10.1016/j.jccase.2015.12.008. PubMed PMID: 30546624; PubMed Central PMCID: PMC6280734.
98. Hamzeh N, Voelker A, Forssén A, Gottschall EB, Rose C, Mroz P, et al. Efficacy of mycophenolate mofetil in sarcoidosis. Respir Med. 2014;108(11):1663-9. Epub 2014/09/28. doi: 10.1016/j.rmed.2014.09.013. PubMed PMID: 25301291; PubMed Central PMCID: PMC4254196.
99. Allison AC, Eugui EM. Mechanisms of action of mycophenolate mofetil in preventing acute and chronic allograft rejection. Transplantation. 2005;80(2 Suppl):S181-90. Epub 2005/10/28. doi: 10.1097/ PubMed PMID: 16251851.
100. Fox RI, Herrmann ML, Frangou CG, Wahl GM, Morris RE, Strand V, et al. Mechanism of action for leflunomide in rheumatoid arthritis. Clin Immunol. 1999;93(3):198-208. Epub 1999/12/22. doi: 10.1006/clim.1999.4777. PubMed PMID: 10600330.
101. Herrmann ML, Schleyerbach R, Kirschbaum BJ. Leflunomide: an immunomodulatory drug for the treatment of rheumatoid arthritis and other autoimmune diseases. Immunopharmacology. 2000;47(2-3):273-89. Epub 2000/07/06. doi: 10.1016/s0162-3109(00)00191-0. PubMed PMID: 10878294.
102. Breedveld FC, Dayer JM. Leflunomide: mode of action in the treatment of rheumatoid arthritis. Ann Rheum Dis. 2000;59(11):841-9. Epub 2000/10/29. doi: 10.1136/ard.59.11.841. PubMed PMID: 11053058; PubMed Central PMCID: PMC1753034.
103. Alvarez PA, Saad AK, Flagel S, Mazzocchi O, Blanco MV. Leflunomide-induced pulmonary hypertension in a young woman with rheumatoid arthritis: a case report. Cardiovasc Toxicol. 2012;12(2):180-3. Epub 2012/01/25. doi: 10.1007/s12012-012-9153-3. PubMed PMID: 22270725.
104. Coirier V, Lescoat A, Chabanne C, Fournet M, Coiffier G, Jouneau S, et al. Pulmonary arterial hypertension in four patients treated by leflunomide. Joint Bone Spine. 2018;85(6):761-3. Epub 2018/01/14. doi: 10.1016/j.jbspin.2017.12.014. PubMed PMID: 29329993.
105. Palasset TL, Chaumais MC, Weatherald J, Savale L, Jais X, Price LC, et al. Association between Leflunomide and Pulmonary Hypertension. Ann Am Thorac Soc. 2021;18(8):1306-15. Epub 2021/01/28. doi: 10.1513/AnnalsATS.202008-913OC. PubMed PMID: 33502958.
106. Conway R, Low C, Coughlan RJ, O'Donnell MJ, Carey JJ. Leflunomide Use and Risk of Lung Disease in Rheumatoid Arthritis: A Systematic Literature Review and Metaanalysis of Randomized Controlled Trials. J Rheumatol. 2016;43(5):855-60. Epub 2016/03/17. doi: 10.3899/jrheum.150674. PubMed PMID: 26980577.
107. Ogino MH, Tadi P. Cyclophosphamide. StatPearls. Treasure Island (FL)2022.
108. Kato Y, Morimoto S, Uemura A, Hiramitsu S, Ito T, Hishida H. Efficacy of corticosteroids in sarcoidosis presenting with atrioventricular block. Sarcoidosis Vasc Diffuse Lung Dis. 2003;20(2):133-7. Epub 2003/07/23. PubMed PMID: 12870723.
109. Chiba T, Nakano M, Hasebe Y, Kimura Y, Fukasawa K, Miki K, et al. Prognosis and risk stratification in cardiac sarcoidosis patients with preserved left ventricular ejection fraction. J Cardiol. 2020;75(1):34-41. Epub 2019/07/02. doi: 10.1016/j.jjcc.2019.04.016. PubMed PMID: 31277963.
110. Khan NA, Donatelli CV, Tonelli AR, Wiesen J, Ribeiro Neto ML, Sahoo D, et al. Toxicity risk from glucocorticoids in sarcoidosis patients. Respir Med. 2017;132:9-14. Epub 2017/09/08. doi: 10.1016/j.rmed.2017.09.003. PubMed PMID: 29229111.
111. Cox CE, Donohue JF, Brown CD, Kataria YP, Judson MA. Health-related quality of life of persons with sarcoidosis. Chest. 2004;125(3):997-1004. doi: 10.1378/chest.125.3.997. PubMed PMID: 15006960.
112. Judson MA, Chaudhry H, Louis A, Lee K, Yucel R. The effect of corticosteroids on quality of life in a sarcoidosis clinic: the results of a propensity analysis. Respir Med. 2015;109(4):526-31. Epub 2015/02/07. doi: 10.1016/j.rmed.2015.01.019. PubMed PMID: 25698652; PubMed Central PMCID: PMC4447298.
113. Hiramitsu S, Morimoto S, Uemura A, Kato Y, Kimura K, Ohtsuki M, et al. National survey on status of steroid therapy for cardiac sarcoidosis in Japan. Sarcoidosis Vasc Diffuse Lung Dis. 2005;22(3):210-3. Epub 2005/12/01. PubMed PMID: 16315784.
114. Okabe T, Yakushiji T, Hiroe M, Oyama Y, Igawa W, Ono M, et al. Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction. ESC Heart Fail. 2016;3(4):288-92. Epub 2016/11/22. doi: 10.1002/ehf2.12095. PubMed PMID: 27867531; PubMed Central PMCID: PMC5107975.
115. Slivnick JA, Betz J, Kalbfleisch S, Crouser ED, Kahwash R. High-dose intravenous glucocorticoids are effective in the acute management of ventricular arrhythmias in cardiac sarcoidosis: A case series. HeartRhythm Case Rep. 2020;6(10):706-10. Epub 2020/10/27. doi: 10.1016/j.hrcr.2020.06.028. PubMed PMID: 33101937; PubMed Central PMCID: PMC7573385.
116. Watanabe H, Eguchi K, Saitou T, Shimpo M, Hiroe M, Kario K. Cardiac sarcoidosis, the complete atrioventricular block of which was completely recovered by intravenous steroid pulse therapy. J Cardiol Cases. 2016;13(1):21-4. Epub 2015/10/20. doi: 10.1016/j.jccase.2015.09.003. PubMed PMID: 30546603; PubMed Central PMCID: PMC6281864.
117. Badsha H, Edwards CJ. Intravenous pulses of methylprednisolone for systemic lupus erythematosus. Semin Arthritis Rheum. 2003;32(6):370-7. Epub 2003/07/02. doi: 10.1053/sarh.2002.50003. PubMed PMID: 12833245.
118. Badsha H, Kong KO, Lian TY, Chan SP, Edwards CJ, Chng HH. Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. Lupus. 2002;11(8):508-13. Epub 2002/09/11. doi: 10.1191/0961203302lu243oa. PubMed PMID: 12220105.
119. Kong KO, Badsha H, Lian TY, Edwards CJ, Chng HH. Low-dose pulse methylprednisolone is an effective therapy for severe SLE flares. Lupus. 2004;13(3):212-3. Epub 2004/05/04. doi: 10.1191/0961203304lu510xx. PubMed PMID: 15119552.
120. Kafil TS, Sparrow R, Khan HR, Manian U, Elrayes M, Bagur R, et al. Intravenous Methylprednisolone for Ventricular Tachycardia Electrical Storm in Cardiac Sarcoidosis: Case Series and 1-Year Follow-up. JACC Clin Electrophysiol. 2021;7(4):536-7. Epub 2021/04/24. doi: 10.1016/j.jacep.2020.12.003. PubMed PMID: 33888271.
121. Jamilloux Y, Cohen-Aubart F, Chapelon-Abric C, Maucort-Boulch D, Marquet A, Pérard L, et al. Efficacy and safety of tumor necrosis factor antagonists in refractory sarcoidosis: A multicenter study of 132 patients. Semin Arthritis Rheum. 2017;47(2):288-94. Epub 2017/03/08. doi: 10.1016/j.semarthrit.2017.03.005. PubMed PMID: 28392046.
122. Krishnan M, Cupps TR, Sheikh FH. Tumor necrosis factor-alpha inhibitor use for treatment of refractory cardiac sarcoidosis in a patient with left ventricular assist device: Adalimumab use in refractory sarcoidosis in a patient with left ventricular assist device. J Heart Lung Transplant. 2020;39(12):1504-5. Epub 2020/08/25. doi: 10.1016/j.healun.2020.08.001. PubMed PMID: 32830024.
123. Miller CT, Sweiss NJ, Lu Y. FDG PET/CT Evidence of Effective Treatment of Cardiac Sarcoidosis With Adalimumab. Clin Nucl Med. 2016;41(5):417-8. doi: 10.1097/RLU.0000000000001124. PubMed PMID: 26828145.
124. Rosenthal DG, Parwani P, Murray TO, Petek BJ, Benn BS, De Marco T, et al. Long-Term Corticosteroid-Sparing Immunosuppression for Cardiac Sarcoidosis. J Am Heart Assoc. 2019;8(18):e010952. Epub 2019/09/06. doi: 10.1161/JAHA.118.010952. PubMed PMID: 31538835; PubMed Central PMCID: PMC6818011.
125. Stievenart J, Le Guenno G, Ruivard M, Rieu V, Andre M, Grobost V. Case Report: TNFalpha Antagonists Are an Effective Therapy in Cardiac Sarcoidosis. Front Cardiovasc Med. 2021;8:676407. Epub 2021/06/29. doi: 10.3389/fcvm.2021.676407. PubMed PMID: 34179141; PubMed Central PMCID: PMC8226185.
126. Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT, Anti TNFTACHFI. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation. 2003;107(25):3133-40. Epub 2003/06/11. doi: 10.1161/01.CIR.0000077913.60364.D2. PubMed PMID: 12796126.
127. Mann DL, McMurray JJ, Packer M, Swedberg K, Borer JS, Colucci WS, et al. Targeted anticytokine therapy in patients with chronic heart failure: results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation. 2004;109(13):1594-602. Epub 2004/03/15. doi: 10.1161/01.CIR.0000124490.27666.B2. PubMed PMID: 15023878.
128. Obi ON, Lower EE, Baughman RP. Biologic and advanced immunomodulating therapeutic options for sarcoidosis: a clinical update. Expert Rev Clin Pharmacol. 2021:1-32. Epub 2021/01/26. doi: 10.1080/17512433.2021.1878024. PubMed PMID: 33487042.
129. Scallon B, Cai A, Solowski N, Rosenberg A, Song XY, Shealy D, et al. Binding and functional comparisons of two types of tumor necrosis factor antagonists. J Pharmacol Exp Ther. 2002;301(2):418-26. Epub 2002/04/19. doi: 10.1124/jpet.301.2.418. PubMed PMID: 11961039.
130. Broos CE, van Nimwegen M, Hoogsteden HC, Hendriks RW, Kool M, van den Blink B. Granuloma formation in pulmonary sarcoidosis. Front Immunol. 2013;4:437. Epub 2013/12/10. doi: 10.3389/fimmu.2013.00437. PubMed PMID: 24339826; PubMed Central PMCID: PMC3857538.
131. Chapelon-Abric C, Saadoun D, Biard L, Sene D, Resche-Rigon M, Hervier B, et al. Long-term outcome of infliximab in severe chronic and refractory systemic sarcoidosis: a report of 16 cases. Clin Exp Rheumatol. 2015;33(4):509-15. Epub 2015/06/29. PubMed PMID: 26120779.
132. Asawaeer M, Widener B, Singhal V, DeVries MJ, Romberger DJ, Erickson AR, et al. Infliximab Treatment of Refractory Cardiac Sarcoidosis. JACC Case Rep. 2020;2(10):1553-7. Epub 2021/07/29. doi: 10.1016/j.jaccas.2020.06.041. PubMed PMID: 34317016; PubMed Central PMCID: PMC8302154.
133. Barnabe C, McMeekin J, Howarth A, Martin L. Successful treatment of cardiac sarcoidosis with infliximab. J Rheumatol. 2008;35(8):1686-7. Epub 2008/08/02. PubMed PMID: 18671332.
134. Baughman RP, Lower EE. Therapy for extrapulmonary sarcoidosis. Semin Respir Crit Care Med. 2002;23(6):589-96. doi: 10.1055/s-2002-36522. PubMed PMID: 16088654.
135. Uthman I, Touma Z, Khoury M. Cardiac sarcoidosis responding to monotherapy with infliximab. Clin Rheumatol. 2007;26(11):2001-3. Epub 2007/03/31. doi: 10.1007/s10067-007-0614-1. PubMed PMID: 17394036.
136. Judson MA, Baughman RP, Costabel U, Flavin S, Lo KH, Kavuru MS, et al. Efficacy of infliximab in extrapulmonary sarcoidosis: results from a randomised trial. Eur Respir J. 2008;31(6):1189-96. Epub 2008/02/06. doi: 10.1183/09031936.00051907. PubMed PMID: 18256069.
137. Crouser ED, Lozanski G, Fox CC, Hauswirth DW, Raveendran R, Julian MW. The CD4+ lymphopenic sarcoidosis phenotype is highly responsive to anti-tumor necrosis factor-{alpha} therapy. Chest. 2010;137(6):1432-5. doi: 10.1378/chest.09-2576. PubMed PMID: 20525654.
138. Jounieaux F, Chapelon C, Valeyre D, Israel Biet D, Cottin V, Tazi A, et al. [Infliximab treatment for chronic sarcoidosis--a case series]. Rev Mal Respir. 2010;27(7):685-92. Epub 2010/07/31. doi: 10.1016/j.rmr.2010.06.011. PubMed PMID: 20863968.
139. Maneiro JR, Salgado E, Gomez-Reino JJ, Carmona L, Group BS. Efficacy and safety of TNF antagonists in sarcoidosis: data from the Spanish registry of biologics BIOBADASER and a systematic review. Semin Arthritis Rheum. 2012;42(1):89-103. Epub 2012/03/02. doi: 10.1016/j.semarthrit.2011.12.006. PubMed PMID: 22387045.
140. Drent M, Cremers JP, Jansen TL, Baughman RP. Practical eminence and experience-based recommendations for use of TNF-alpha inhibitors in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2014;31(2):91-107. PubMed PMID: 25078637.
141. Syed H, Ascoli C, Linssen CF, Vagts C, Iden T, Syed A, et al. Infection prevention in sarcoidosis: proposal for vaccination and prophylactic therapy. Sarcoidosis Vasc Diffuse Lung Dis. 2020;37(2):87-98. Epub 2020/10/24. doi: 10.36141/svdld.v37i2.9599. PubMed PMID: 33093774; PubMed Central PMCID: PMC7569559.
142. Wijnen PA, Cremers JP, Nelemans PJ, Erckens RJ, Hoitsma E, Jansen TL, et al. Association of the TNF-alpha G-308A polymorphism with TNF-inhibitor response in sarcoidosis. Eur Respir J. 2014;43(6):1730-9. Epub 2014/02/22. doi: 10.1183/09031936.00169413. PubMed PMID: 24558177.
143. Judson MA, Baughman RP, Costabel U, Mack M, Barnathan ES. The potential additional benefit of infliximab in patients with chronic pulmonary sarcoidosis already receiving corticosteroids: a retrospective analysis from a randomized clinical trial. Respir Med. 2014;108(1):189-94. Epub 2013/12/10. doi: 10.1016/j.rmed.2013.11.019. PubMed PMID: 24361164.
144. Jounieaux F, Chapelon C, Valeyre D, Israel Biet D, Cottin V, Tazi A, et al. [Infliximab treatment for chronic sarcoidosis--a case series]. Rev Mal Respir. 2010;27(7):685-92. Epub 2010/09/25. doi: 10.1016/j.rmr.2010.06.011. PubMed PMID: 20863968.
145. Lower EE, Sturdivant M, Grate L, Baughman RP. Use of third-line therapies in advanced sarcoidosis. Clin Exp Rheumatol. 2019. Epub 2019/11/20. PubMed PMID: 31820728.
146. Sandborn WJ, Rutgeerts P, Enns R, Hanauer SB, Colombel JF, Panaccione R, et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med. 2007;146(12):829-38. Epub 2007/05/02. doi: 10.7326/0003-4819-146-12-200706190-00159. PubMed PMID: 17470824.
147. Sandborn WJ, Hanauer S, Loftus EV, Jr., Tremaine WJ, Kane S, Cohen R, et al. An open-label study of the human anti-TNF monoclonal antibody adalimumab in subjects with prior loss of response or intolerance to infliximab for Crohn's disease. Am J Gastroenterol. 2004;99(10):1984-9. Epub 2004/09/28. doi: 10.1111/j.1572-0241.2004.40462.x. PubMed PMID: 15447761.
148. Crommelin HA, van der Burg LM, Vorselaars AD, Drent M, van Moorsel CH, Rijkers GT, et al. Efficacy of adalimumab in sarcoidosis patients who developed intolerance to infliximab. Respir Med. 2016;115:72-7. Epub 2016/04/23. doi: 10.1016/j.rmed.2016.04.011. PubMed PMID: 27215507.
149. Baughman RP, Lower EE, Drent M. Inhibitors of tumor necrosis factor (TNF) in sarcoidosis: who, what, and how to use them. Sarcoidosis Vasc Diffuse Lung Dis. 2008;25(2):76-89. PubMed PMID: 19382527.
150. Bartelds GM, Wijbrandts CA, Nurmohamed MT, Stapel S, Lems WF, Aarden L, et al. Clinical response to adalimumab: relationship to anti-adalimumab antibodies and serum adalimumab concentrations in rheumatoid arthritis. Ann Rheum Dis. 2007;66(7):921-6. Epub 2007/02/16. doi: 10.1136/ard.2006.065615. PubMed PMID: 17301106; PubMed Central PMCID: PMC1955110.
151. Plosker GL, Figgitt DP. Rituximab: a review of its use in non-Hodgkin's lymphoma and chronic lymphocytic leukaemia. Drugs. 2003;63(8):803-43. Epub 2003/03/29. doi: 10.2165/00003495-200363080-00005. PubMed PMID: 12662126.
152. Cerny T, Borisch B, Introna M, Johnson P, Rose AL. Mechanism of action of rituximab. Anticancer Drugs. 2002;13 Suppl 2:S3-10. Epub 2003/04/25. doi: 10.1097/00001813-200211002-00002. PubMed PMID: 12710585.
153. Krause ML, Cooper LT, Chareonthaitawee P, Amin S. Successful use of rituximab in refractory cardiac sarcoidosis. Rheumatology (Oxford). 2016;55(1):189-91. Epub 2015/09/16. doi: 10.1093/rheumatology/kev309. PubMed PMID: 26370399.
154. Elwazir M, Krause ML, Bois JP, Christopoulos G, Kendi AT, Cooper JLT, et al. Rituximab for the Treatment of Refractory Cardiac Sarcoidosis: A Single-Center Experience. J Card Fail. 2022;28(2):247-58. Epub 2021/07/29. doi: 10.1016/j.cardfail.2021.07.008. PubMed PMID: 34320381.
155. Lower EE, Sturdivant M, Grate L, Baughman RP. Use of third-line therapies in advanced sarcoidosis. Clin Exp Rheumatol. 2020;38(5):834-40. Epub 2019/12/11. PubMed PMID: 31820728.
156. Nagai T, Nagano N, Sugano Y, Asaumi Y, Aiba T, Kanzaki H, et al. Effect of Discontinuation of Prednisolone Therapy on Risk of Cardiac Mortality Associated With Worsening Left Ventricular Dysfunction in Cardiac Sarcoidosis. Am J Cardiol. 2016;117(6):966-71. Epub 2015/12/31. doi: 10.1016/j.amjcard.2015.12.033. PubMed PMID: 26805658.