title: TNF-α: a treatment target or cause of sarcoidosis?
abstract: Sarcoidosis is a systemic granulomatous disease that affects numerous organs, commonly manifesting at the lungs and skin. While corticosteroids remain the first line of treatment, tumour necrosis factor alpha (TNF-α) inhibitors have been investigated as one potential steroid sparing treatment for sarcoidosis. TNF-α is one of many components involved in the formation of granulomas in sarcoidosis. While there have been larger scale studies of biologic TNF-α inhibition in systemic sarcoidosis, studies in cutaneous disease are limited. Paradoxically, in some patients treated with biologic TNF-α inhibitors for other diseases, treatment can induce the development of sarcoidosis. In the light of this complexity, we discuss the role of TNF-α in granuloma formation, the therapeutic role of TNF-α inhibition and immunologic abnormalities following treatment with these TNF-α inhibitors including drug-specific alterations involving interferon-γ, lymphotoxin-α, TNF receptor 2 (TNFR2) and T-regulatory cells.
authors.affiliation: Department of Dermatology, University of California Irvine Health, Irvine, CA, USA.|Department of Internal Medicine, MacNeal Hospital, Berwyn, IL, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Amber
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bloom
authors.affiliation: Psoriasis-Center, Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Kiel, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Mrowietz
authors.affiliation: Department of Dermatology and Allergology, Philipps University, Marburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hertl
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D000068800:Etanercept / Q000627:therapeutic use; D006099:Granuloma / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use; D008171:Lung Diseases / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D058990:Molecular Targeted Therapy; D012507:Sarcoidosis / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D012871:Skin Diseases / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D013792:Thalidomide / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001688:Biological Products; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D013792:Thalidomide; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept