Anti-TNF Treatment In Refractory Sarcoidosis; Therapeutic Impacts Of Adalimumab And Infliximab

Abstract

Introduction:Sarcoidosis is a chronic inflammatory disease characterized by granuloma formation in various organs, commonly affecting the lungs. While corticosteroids are the mainstay of treatment, some patients develop refractory sarcoidosis that is resistant to conventional therapies. Tumor necrosis factor-alpha (TNF-α) plays a crucial role in the disease’s pathogenesis, and anti-TNF agents like adalimumab and infliximab have emerged as promising treatments for refractory cases. This study investigates the therapeutic impacts of these biologics on lung function and inflammation in refractory sarcoidosis.

Method:This prospective case-control study included 60 refractory sarcoidosis patients from Al-Azhar hospitals, Egypt, divided into three groups of 20 based on treatment: adalimumab, infliximab, or conventional therapy. Data collected included demographics, medication use, pulmonary function tests (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], and diffusing capacity of the lung for carbon monoxide [DLCO]), and serum inflammatory markers (angiotensin-converting enzyme [ACE] levels, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]) using standardized clinical and laboratory methods. Primary outcomes include the comparison of these measurements between the three treatment groups.

Results: The study results indicate that biologic therapies, especially adalimumab and infliximab, significantly improve lung function compared to conventional treatment in refractory sarcoidosis; both drugs enhanced pulmonary function parameters, with adalimumab showing a slight but not statistically significant advantage. Additionally, these biologics effectively reduced serum ACE and inflammatory markers such as ESR and CRP; although adalimumab tended to outperform infliximab in these measures, the differences are generally not significant.

Conclusion:The study concludes that biologic therapies, adalimumab and infliximab, significantly improve lung function and reduce inflammation in refractory sarcoidosis. Although adalimumab showed a slight advantage over infliximab, the differences were not statistically significant.