title: Efficacy of adalimumab in sarcoidosis patients who developed intolerance to infliximab.
abstract: Tumor necrosis factor-alpha (TNF-α) inhibitors are regarded as the third-line therapy in sarcoidosis, the first choice generally being infliximab. To date, data regarding response to adalimumab in sarcoidosis patients intolerant to infliximab are lacking. The objective of this retrospective observational study was to establish if adalimumab could achieve stabilization or improvement of the disease in refractory sarcoidosis patients who developed intolerance to infliximab.
  
  
  
  Sarcoidosis patients referred to St Antonius Interstitial Lung Diseases Center of Excellence, Nieuwegein, The Netherlands, between January 2008 and April 2015 who switched from infliximab to adalimumab were included. Changes in organ function, inflammatory biomarker levels, and adverse events were retrieved from medical records.
  
  
  
  Out of 142 infliximab treated patients, 18 (13%) had to discontinue treatment due to antibody formation or severe adverse events and switched to adalimumab therapy. Organ function improved in 7 patients (39%), was stable in 6 patients (33%), and worsened in 5 patients (28%) after 12 months of treatment or after 6 months if evaluation after 12 months was not available (n = 4). In none of the patients biomarker levels of soluble interleukin-2 receptor (sIL-2R) deteriorated. Median decrease in sIL-2R was 3614 pg/mL. Most reported adverse event was infection (n = 10).
  
  
  
  Adalimumab is an effective alternative for patients intolerant to infliximab. The switch to adalimumab achieved clinical improvement in 39% and stabilization in 33% of patients intolerant to infliximab. Further research is needed to develop guidelines on how to use adalimumab for sarcoidosis in terms of dosing regimen.
authors.affiliation: Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Heleen A
authors.initials: HA
authors.lastname: Crommelin
authors.affiliation: Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands; Science Department, University College Roosevelt, Middelburg, The Netherlands.
authors.forename: Leone M
authors.initials: LM
authors.lastname: van der Burg
authors.affiliation: Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Adriane D M
authors.initials: AD
authors.lastname: Vorselaars
authors.affiliation: Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Drent
authors.affiliation: Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, The Netherlands.
authors.forename: Coline H M
authors.initials: CH
authors.lastname: van Moorsel
authors.affiliation: Science Department, University College Roosevelt, Middelburg, The Netherlands; Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Ger T
authors.initials: GT
authors.lastname: Rijkers
authors.affiliation: Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: v.deneer@antoniusziekenhuis.nl.
authors.forename: Vera H M
authors.initials: VH
authors.lastname: Deneer
authors.affiliation: Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands; Division of Heart and Lungs, University Medical Center Utrecht, The Netherlands.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Grutters
mesh_terms: D000068879:Adalimumab / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000494:pharmacology*; D004342:Drug Hypersensitivity; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015375:Receptors, Interleukin-2; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects / Q000037:antagonists & inhibitors* / Q000378:metabolism; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D015375:Receptors, Interleukin-2; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Adalimumab; Anti-TNF-α; Infliximab; Sarcoidosis