Neoznačeni inhibitori TNF-alfa
Neoznačeni inhibitori TNF-alfa mogu olakšati sarkoidozu koju je teško liječiti
"Liječenje može spriječiti pogoršanje izvanplućne sarkoidoze"
Korištenje TNF-alfa inhibitora izvan propisane svrhe može pomoći nekim osobama sa sarkoidozom koju je teško liječiti da olakšaju svoje simptome ili spriječe njihovo pogoršanje, prema studiji meta-analize.
Podaci su također pokazali da ovi inhibitori, posebice Remicade (infliximab), mogu djelovati malo bolje na pacijente koji imaju simptome sarkoidoze i izvan pluća (izvanplućna sarkoidoza) nego na one koji imaju samo zahvaćena pluća ( plućna sarkoidoza ).
Studija, " Uloga anti-tumor necrosis factor-alpha agenata u liječenju sarkoidoze: meta-analiza ," objavljena je u European Journal of Internal Medicine .
About one in 10 U.S. sarcoidosis patients use TNF-alpha inhibitors off label
Sarcoidosis occurs when white blood cells accumulate in small clusters called granulomas and cause inflammation of body tissues. Most people with sarcoidosis have lung problems, often presenting as shortness of breath and a persistent dry cough.
Many people do not need treatment, but when pharmacological treatment is recommended it usually includes corticosteroids to reduce inflammation. If corticosteroids are insufficient or there are concerns about side effects, other immunosuppressive treatments may sometimes be used.
Although they are not approved for sarcoidosis, about one in 10 U.S. patients with sarcoidosis who do not respond well to other medicines use TNF-alpha inhibitors off label.
TNF-alpha inhibitors work by blocking the activity of TNF-alpha, a molecule present in large amounts in inflamed tissues, where it helps prolong inflammation. By suppressing TNF-alpha, these treatments are expected to reduce inflammation. Evidence on anti-TNF-alpha treatment for refractory sarcoidosis has been “mixed and inconclusive,” the researchers wrote.
Meta-analysis included 398 patients with sarcoidosis
To learn more, researchers in Iran and the United States conducted a meta-analysis, combining data from several studies in the literature. They systematically reviewed studies published up to 10 April 2022 that reported the effectiveness of TNF-alpha inhibitors in people with pulmonary and extrapulmonary sarcoidosis in clinical trials.
Of 22 studies assessed for eligibility, eight—including 398 patients with sarcoidosis—were included. Most trials were conducted in the United States. Four tested Remicade, two used etanercept (sold as Enbrel), one assessed adalimumab (sold as Humira, with biosimilars available), and one tested Simponi (golimumab) combined with Stelara (ustekinumab).
The average patient age was 48.5 years, and treatment lasted from 14 weeks (3.5 months) to 45 weeks (about 10 months). All medicines were given by injection under the skin except Remicade, which was given directly into the bloodstream.
Treatment success, defined as reduced symptoms or absence of disease progression, was observed in 69.9% of people with pulmonary sarcoidosis. Among those with extrapulmonary sarcoidosis, the rate was slightly higher (74.5%).
When outcomes were examined by organ involvement, Remicade appeared to work best, both for pulmonary sarcoidosis (80%–100% success) and extrapulmonary sarcoidosis (93%–100% success).
Etanercept was associated with a 31% success rate among patients with pulmonary sarcoidosis and 66% among those with eye manifestations. For skin lesions associated with sarcoidosis, adalimumab reduced or stabilised symptoms in 60% of patients, while the Simponi–Stelara combination was associated with a 32% success rate.
Although the meta-analysis was limited to a small number of clinical trials, the researchers wrote that treatment of refractory sarcoidosis with anti-TNF-alpha agents was effective in both pulmonary and extrapulmonary sarcoidosis, with slightly greater effectiveness in extrapulmonary disease.
“We found that effectiveness varied according to disease location and choice of agent,” the team wrote, adding that Remicade was the most common and effective agent across sarcoidosis types.
Although adalimumab and etanercept showed relatively high success rates in extrapulmonary sarcoidosis, the data do not support using Simponi and Stelara for sarcoidosis.
“Although TNF-alpha inhibitors are a last treatment option for some patients, they appear to be a practical and favourable treatment option,” the researchers wrote.
Appropriately controlled clinical trials using a standardised definition of objective treatment success are needed to confirm these findings.
Author: Dr Margarida Maia
Margarida Maia, PhD | 6 January 2023
Source: https://sarcoidosisnews.com/news/off-label-tnf-alpha-inhibitors-ease-hard-treat-sarcoidosis/