Outcome of patients with sarcoidosis refractory to TNF antagonists: a case series

Clémence Thery-Casari; Yvan Jamilloux; Diane Bouvry; Catherine Chapelon-Abric; Alicia Marquet; Philip Bielefeld; Nicolas Schleinitz; Sandra Vukusic; Nicolas Girszyn; Olivier Fain; Fabrice Bonnet; Dominique Valeyre; Pascal Seve

doi:10.36141/svdld.v35i4.6999

Outcome of patients with sarcoidosis refractory to TNF antagonists: a case series

Authors

Clémence Thery-Casari service de médecine interne hôpital de la croix rousse Université lyon 1Groupe Sarcoïdose Francophone.
Yvan Jamilloux Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université Claude Bernard Lyon 1, Villeurbanne, France Groupe Sarcoïdose Francophone.
Diane Bouvry Service de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, Bobigny, France Groupe Sarcoïdose Francophone.
Catherine Chapelon-Abric Service de Médecine Interne et d’Immunologie Clinique, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, FranceGroupe Sarcoïdose Francophone.
Alicia Marquet Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, FranceUniversité Claude Bernard Lyon 1, Villeurbanne, FranceGroupe Sarcoïdose Francophone.
Philip Bielefeld Service de Médecine Interne, Centre Hospitalier Universitaire de Dijon, Dijon, France Groupe Sarcoïdose Francophone.
Nicolas Schleinitz Service de Médecine Interne, Hôpital de le Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceGroupe Sarcoïdose Francophone.
Sandra Vukusic Service de Neurologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France Groupe Sarcoïdose Francophone.
Nicolas Girszyn Service de Médecine Interne, Centre Hospitalier Universitaire de Rouen, Rouen, France Groupe Sarcoïdose Francophone.
Olivier Fain Service de Médecine Interne, Centre Hospitalier Universitaire Saint Antoine, Assistance Publique-Hôpitaux de Paris, Université Paris 6, Paris, France Groupe Sarcoïdose Francophone.
Fabrice Bonnet Service de Médecine Interne et de Maladies Infectieuses Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France Groupe Sarcoïdose Francophone.
Dominique Valeyre Service de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, Bobigny, France Groupe Sarcoïdose Francophone.
Pascal Seve Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, FranceUniversité Claude Bernard Lyon 1, Villeurbanne, FranceGroupe Sarcoïdose Francophone.

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Abstract

Background: Tumor necrosis factor (TNF) antagonists have been reported as an efficient third-line therapy for sarcoidosis but there is no data regarding patients who do not respond to this treatment. Objective: To report the characteristics, the outcome and the response to therapy of patients with sarcoidosis resistant to TNF antagonists. Methods: Patients from the French STAT (Sarcoidosis Treatment with Anti-TNF) registry who were classified as non-responders and who were followed-up for >1 year were included. The response to further therapies was classified as complete response, or partial response, and the others were classified as non-responders. Results: Among the 132 patients from the registry, 14 were considered as non-responders to anti-TNF. Nine patients (66% of women; mean age 48 years) were analyzed. The mean number of organs involved was 4.2. Seven patients were previously treated with more than 2 immunosuppressive treatments. The mean duration of the anti-TNF treatment was 9 months (range, 3-24). After a mean follow-up duration of 58 months (median, 35; range, 19-128) a complete response was observed in 2/9 cases, a partial response in 5/9 cases, and 2/9 cases were considered as non-responders. In all but one patient, the immunosuppressant that allowed the clinical response had previously been used. Furthermore, the dosage was not necessarily increased to gain efficacy. Non-responders were treated by corticosteroids only because of their comorbidities or noncompliance. Conclusion: In patients who do not respond to TNF antagonists, previously used immunosuppressants may be useful. Excluding a differential diagnosis, assessing compliance and testing for anti-drug antibodies should be systematic.