title: Efficacy and safety of tumor necrosis factor antagonists in refractory sarcoidosis: A multicenter study of 132 patients.
abstract: The off-label use of TNF antagonists in refractory sarcoidosis is increasingly reported but data on their efficacy and safety are still insufficient.
  
  
  
  To report on efficacy and safety of TNF antagonists in severe and refractory sarcoidosis.
  
  
  
  Examination of retrospective demographic, clinical, therapeutic, and adverse event data on 132 sarcoidosis patients (58% women; mean (min-max) age = 45.5 (14-78) years) given TNF antagonists (mainly infliximab, 91%) and investigation of response-linked factors.
  
  
  
  The overall clinical response (complete and partial) rate was 64%. TNF-antagonist efficacy (i.e., significant decrease of the ePOST score) was noted in cases with neurologic, heart, skin, and upper respiratory tract involvements. No significant difference in efficacy was found between anti-TNF used alone and TNF with immunosuppressant. The use of anti-TNF allowed reducing prednisone dosage at end of follow-up (p < 0.001). Adverse events were observed in 52% of the patients; they included infections (36%) and allergic reactions (8%) and required treatment interruption in 31 cases (23%). When TNF antagonists were interrupted, 13 patients experienced relapses within 14 months on average (median follow-up: 20.5 months).
  
  
  
  TNF antagonists were efficacious in about two-thirds of patients with severe/refractory sarcoidosis but their use led to a high rate of adverse events.
authors.affiliation: Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande rue de la Croix-Rousse F-69004, Lyon, France; Université Claude Bernard-Lyon 1, Villeurbanne, France.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Jamilloux
authors.affiliation: Service de Médecine Interne 2, Institut E3M, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France.
authors.forename: Fleur
authors.initials: F
authors.lastname: Cohen-Aubart
authors.affiliation: Service de Médecine Interne et d׳Immunologie Clinique, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chapelon-Abric
authors.affiliation: Université Claude Bernard-Lyon 1, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Université Claude Bernard-Lyon 1, Villeurbanne, France; Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-Lyon, France.
authors.forename: Alicia
authors.initials: A
authors.lastname: Marquet
authors.affiliation: Université Claude Bernard-Lyon 1, Villeurbanne, France; Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Pérard
authors.affiliation: Clinique de médecine interne, pôle pluridisciplinaire de médecine et de gérontologie clinique, Centre Hospitalier Universitaire Grenoble-Alpes, CS10217, Grenoble, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bouillet
authors.affiliation: Clinique de médecine interne, pôle pluridisciplinaire de médecine et de gérontologie clinique, Centre Hospitalier Universitaire Grenoble-Alpes, CS10217, Grenoble, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Deroux
authors.affiliation: Service de Médecine Interne, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Abad
authors.affiliation: Service de Médecine Interne, Centre Hospitalier Universitaire Le Bocage, Dijon, France.
authors.forename: Philip
authors.initials: P
authors.lastname: Bielefeld
authors.affiliation: Service de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, Bobigny, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Bouvry
authors.affiliation: Service de Médecine Interne, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: Marc
authors.initials: M
authors.lastname: André
authors.affiliation: Service de Médecine Interne et d׳Immunologie Clinique, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, UMR 1184, Le Kremlin Bicêtre, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noel
authors.affiliation: Service de Médecine Interne, Centre Hospitalier Universitaire de Caen, Caen, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Bienvenu
authors.affiliation: Service de Médecine Interne, Centre Hospitalier Universitaire de Rouen Rouen, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Proux
authors.affiliation: Université Claude Bernard-Lyon 1, Villeurbanne, France; Service de Neurologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Vukusic
authors.affiliation: Service d׳Ophtalmologie, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France.
authors.forename: Bahram
authors.initials: B
authors.lastname: Bodaghi
authors.affiliation: Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-Lyon, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Sarrot-Reynauld
authors.affiliation: Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Iwaz
authors.affiliation: Service de Médecine Interne 2, Institut E3M, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France.
authors.forename: Zahir
authors.initials: Z
authors.lastname: Amoura
authors.affiliation: Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande rue de la Croix-Rousse F-69004, Lyon, France; Université Claude Bernard-Lyon 1, Villeurbanne, France.
authors.forename: Christiane
authors.initials: C
authors.lastname: Broussolle
authors.affiliation: Service de Médecine Interne et d׳Immunologie Clinique, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.affiliation: Service de Médecine Interne et d׳Immunologie Clinique, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Saadoun
authors.affiliation: Service de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, Bobigny, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Valeyre
authors.affiliation: Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande rue de la Croix-Rousse F-69004, Lyon, France; Université Claude Bernard-Lyon 1, Villeurbanne, France. Electronic address: pascal.seve@chu-lyon.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sève
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Efficacy; Safety; Sarcoidosis; TNF antagonist