Open AccessEffect of the TNF‐α inhibitor adalimumab in patients with recalcitrant sarcoidosis: a prospective observational study using FDG‐PET
Author(s) -
Milman Nils,
Graudal Niels,
Loft Annika,
Mortensen Jann,
Larsen Janni,
Baslund Bo
Publication year - 2012
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/j.1752-699x.2011.00276.x
Subject(s) - medicine , adalimumab , sarcoidosis , standardized uptake value , positron emission tomography , concomitant , nuclear medicine , prospective cohort study , gastroenterology , tumor necrosis factor alpha
Background: Tumour necrosis factor‐alpha (TNF‐α) plays a crucial role in sarcoidosis. In severe disease, treatment with TNF‐α inhibitors may be effective. Objectives: Changes in sarcoid disease activity were assessed by fluorine‐18‐fluorodeoxyglucose positron emission tomography (FDG‐PET) in patients with recalcitrant sarcoidosis treated with adalimumab. Methods: Prospective 24‐week observational study. Patients continued medication with steroids and antimetabolites and received adalimumab 40 mg subcutaneously every other week. Ten patients with biopsy‐proven sarcoidosis (two men) were included with a median age of 47 years (range 35–73). An FDG‐PET showing uptake indicating sarcoid activity was required at inclusion and repeated at the end of the study. FDG‐PET uptake was assessed by calculated standardised uptake value (SUV). Blood samples and lung function tests were performed regularly. Quality of life was assessed by the short‐form health survey (SF‐36) questionnaire. Results: Following treatment with adalimumab, FDG‐PET uptake decreased in nine patients ( P = 0.011) and increased in one patient. Maximum SUV fell from median 14.1 to 7.0 ( P < 0.03), and mean SUV fell from median 6.5 to 2.9 ( P < 0.02). Six patients had uptake in the lungs, which decreased after treatment ( P = 0.035). Six patients had uptake in the lymph nodes, which decreased after treatment in five patients ( P = 0.035). Four patients had non‐lymphatic extrathoracic uptake, which decreased after treatment ( P = 0.05). There was no effect of adalimumab on pulmonary function tests, serum angiotensin I converting enzyme and blood lymphocyte (CD3+, CD4+, CD8+) concentrations. Physical component summary score (SF‐36) increased during treatment, mental component summary score was unchanged. Conclusion: In sarcoidosis, treatment with adalimumab can reduce disease activity, as assessed by FDG‐PET. Please cite this paper as: Milman N, Graudal N, Loft A, Mortensen J, Larsen J and Baslund B. Effect of the TNF‐α inhibitor adalimumab in patients with recalcitrant sarcoidosis: a prospective observational study using FDG‐PET. Clin Respir J 2012; DOI:10.1111/j.1752‐699X.2011.00276.x.