Elsevier

Respiratory Medicine

Volume 115, June 2016, Pages 72-77
Respiratory Medicine

Efficacy of adalimumab in sarcoidosis patients who developed intolerance to infliximab

https://doi.org/10.1016/j.rmed.2016.04.011Get rights and content
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Highlights

  • Sarcoidosis patients intolerant to infliximab who switched to adalimumab were studied.

  • Clinically, 39% of patients improved, 33% were stable and 28% deteriorated.

  • Inflammatory response was present in 61% of patients.

  • Adalimumab appeared to be a good alternative for infliximab.

  • Future studies should focus on finding the optimal dosing regimen of adalimumab.

Abstract

Background

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.

Material and methods

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.

Results

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).

Conclusions

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.

Keywords

Adalimumab
Infliximab
Sarcoidosis
Anti-TNF-α

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