Sarcoidosis: is there a role for anti-TNF-α?

In severe cases of sarcoidosis treatment can be very difficult. The common treatment strategies might be failing. Tumour necrosis factor (TNF) α therapy is approved in rheumatoid arthritis, M. Crohn, psoriasis and ankylosing spondylitis. In sarcoidosis more recently a phase 2, multicenter, randomized, double-blind, placebo-controlled study was conducted in 138 patients with chronic sarcoidosis with pulmonary involvement. Patients in the combined infliximab groups (3 and 5 mg/kg) had a statistically significant improvement of the FVC (mean increase of 2.5% from baseline to week 24 in the percent of predicted FVC, compared with no change in placebo-treated patients (p = 0.038)). Studies in the earlier mentioned diseases revealed that inadequate treatment responses could result from incomplete suppression of TNF α activity. This suggests that increasing patients’ dose or frequency of infliximab could in turn improve their clinical response. Further evaluation of anti-TNF therapy in symptomatic patients with severe, chronic sarcoidosis is needed.