Highlights
- •Anti-TNF-α therapy is effective in both pulmonary and extrapulmonary sarcoidosis.
- •Anti-TNF-α therapy has higher efficacy in extrapulmonary compared to pulmonary sarcoidosis (75% vs. 70%).
- •Treatment with Infliximab and Adalimumab show the highest efficacy in sarcoidosis.
Abstract
Importance
Anti-tumor necrosis factor-alpha agent (anti-TNF-α) is considered an effective third-line
therapy for refractory sarcoidosis,studies observing the efficacy of anti-TNF-α agents
show conflicting results.
Objective
We performed an up-to-date systemic meta-analysis to determine effectiveness and further
elucidate the role of anti-TNF-α in the treatment of sarcoidosis.
Data sources
A systematic search was carried out in PubMed/Medline, EMBASE, and Cochrane Library
for studies reporting the therapeutic effects of anti-TNF drugs on patients with pulmonary
and extra-pulmonary sarcoidosis, published up to April 10, 2022. The study was registered
in the international prospective register of systematic reviews (PROSPERO) under ID:
CRD42022364614.
Study selection
Clinical trials written reporting the therapeutic effects of anti-TNF drugs on patients
with pulmonary and extra-pulmonary sarcoidosis were included.
Data extraction and synthesis
Statistical analyses were performed with Comprehensive Meta-Analysis software, and
the random-effects model was used. The combined overall treatment success was determined
for patients with pulmonary and extrapulmonary sarcoidosis.
Main outcomes and measures
Overall treatment success rate wasdefined as no disease progression or improvement
in symptoms.
Results
Eight clinical trial articles were included in the meta-analysis; four used Infliximab,
two Etanercept, one Adalimumab, and one Ustekinumab and Golimumab. The mean age of
participants was 48.5 years. The duration of drug therapy ranged from 14 to 45 weeks.
We found a combined overall treatment success rate, defined as no disease progression
or improvement in symptoms, of 69.9% (95% CI 35.0-90.9, I2: 70%) in the pulmonary
sarcoidosis group and 74.5% (95% CI 36.3-93.7, I2: 90%) in the extrapulmonary sarcoidosis
group. There was no evidence of publication bias in either group.
Conclusion and relevance
Treatment of refractory sarcoidosis with anti-TNF-α agents was effective in both pulmonary
and extrapulmonary sarcoidosis, with a slightly higher efficacy seen in extrapulmonary
sarcoidosis. Further randomized controlled trials should be conducted to determine
the effects of anti-TNF-α agents as a part of the management strategy of sarcoidosis.
Patients with pulmonary sarcoidosis should be studied separately from patients with
extrapulmonary sarcoidosis to adjust for confounding results.
Abbreviations:
TNF-α (Tumor necrosis factor-alpha)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 14, 2022
Accepted:
December 8,
2022
Received in revised form:
December 6,
2022
Received:
July 18,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
