Clinical and Imaging Response to Tumor Necrosis Factor Alpha Inhibitors in Treatment of Cardiac Sarcoidosis: A Multicenter Experience.
Citation: Journal of Cardiac Failure. 27(1):83-91, 2021 Jan.PMID: 32889044Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Medicine/Nuclear Medicine | Medicine/RheumatologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiomyopathies | *Heart Failure | *Sarcoidosis | Cardiomyopathies/dg [Diagnostic Imaging] | Cardiomyopathies/dt [Drug Therapy] | Female | Fluorodeoxyglucose F18 | Humans | Male | Middle Aged | Positron-Emission Tomography | Radiopharmaceuticals | Retrospective Studies | Sarcoidosis/dg [Diagnostic Imaging] | Sarcoidosis/dt [Drug Therapy] | Stroke Volume | Tumor Necrosis Factor-alpha | Ventricular Function, LeftYear: 2021Local holdings: Available online from MWHC library: 1995 - presentISSN:- 1071-9164
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 32889044 | Available | 32889044 |
Available online from MWHC library: 1995 - present
BACKGROUND: Cardiac sarcoidosis (CS) is an increasingly recognized cause of cardiomyopathy, however data on immunosuppressive strategies are limited. Treatment with tumor necrosis factor (TNF) alpha inhibitors is not well described; moreover, there may be heart failure (HF)-related safety concerns.
CONCLUSIONS: TNF alpha inhibitor treatment guided by FDG-PET may minimize corticosteroid use and effectively reduce cardiac inflammation without significant adverse effect on cardiac function. However infections were common, some of which were serious, and therefore patients require close monitoring for both infection and cardiac symptoms. Copyright (c) 2020. Published by Elsevier Inc.
METHODS: Retrospective multicenter study of TNF alpha inhibitor treated CS patients. Baseline characteristics, treatments, and outcomes were adjudicated.
RESULTS: Thirty-eight patients with CS (mean 49.9 years old, 42% women, 53% African American) were treated with TNF alpha inhibitor (30 infliximab, 8 adalimumab). Prednisone dose decreased from time of TNF alpha inhibitor initiation (21.7+/-17.5 mg) to 6-months (10.4+/-6.1 mg, p=0.001) and 12-months post (7.3+/-7.3 mg, p=0.002). On pre-TNF alpha inhibitor treatment 18-flourodoxyglucose position emission tomography (FDG-PET), 84% of patients had cardiac FDG uptake. Post-treatment, there was a significant decrease in number of segments involved (3.5+/-3.8 to 1+/-2.5, p=0.008) and maximum standardized uptake value (3.59+/-3.7 to 0.57+/-1.6, p=0.0005), with 73% of patients demonstrating complete resolution or improvement of cardiac FDG uptake. Left ventricular ejection fraction remained stable (45+/-16.5 to 47+/-15.0%, p=0.10). Four patients required inpatient HF treatment, and 8 had infections; 2 required treatment cessation.
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