Efficacy and Tolerance of TNF alpha Inhibitor Treatment in Cardiac Sarcoidosis

Background: Cardiac Sarcoidosis (CS) accounts for 85% of sarcoidosis-related deaths in Japan and 13-25% in North America. Objective: To evaluate effectiveness and tolerance of TNF alpha inhibitor (TNFI) treatment in CS. Methods: From a French multicenter cohort of patients with extra-thoracic sarcoidosis, we retrospectively analyzed patients who fulfilled following inclusion criteria: A definite histologically proven extra-thoracic sarcoidosis • A diagnosis of CS based on the 2011-Heart Rhythm Society consensus, and • who received a TNFI. The response to TNFI treatment was analyzed on cardiac clinical symptoms/signs and cardiac imaging • abnormalities. Complete responders showed a complete normalization of all baseline abnormal exams. Results: Among 19 patients, baseline characteristics included chest pain/heart failure (42%) and abnormal findings on cardiac MRI (73%), EKG (72%), echocardiography (59%), thallium scintigraphy (69%) and 18 FDG PET scan (44%). CS was refractory to corticosteroids plus immunosuppressant i.e. methotrexate (n=14/19), cyclophosphamide (n=10/19), azathioprine (n=7/19), and mycophenolate mofetyl (n=3/19). After a mean follow up of 36.6 months, 26.3% of patients were complete responders and 47.4% partial responders. The mean daily dose of corticosteroids was 21.4 mg at baseline versus 10.9 mg at the last visit (p<0.001). Four patients had to withdraw TNFI because of infection. Three patients died (lung cancer, infection-related respiratory failure, cardiac failure). DOI: 10.29011/IJEACR-121. 000021 Citation: Puyraimond-Zemmour D, Chapelon-Abric C, Bouvry D, Ruivard M, André M, et al. (2018) Efficacy and Tolerance of TNF alpha Inhibitor Treatment in Cardiac Sarcoidosis. Int J Exp Clin Res: IJEACR-121. DOI: 10.29011/IJEACR-121. 000021 2 Volume 2018; Issue 01 Conclusion: TNF alpha inhibitor treatment led to a complete/partial cardiac response in 74% of patients with a cardiac sarcoidosis refractory to immunosuppressant, with a steroid sparing-effect. Adverse infectious events led to TNF alpha inhibitor withdrawal in 21% of patients. Key Messages TNF inhibitor appears to be an effective treatment with a complete/partial response in 74% of patients with a cardiac sarcoi• dosis refractory to immunosuppressant. TNFI inhibitor should be used with cautious in patients with a cardiac sarcoidosis refractory to corticosteroid and immuno• suppressive therapy. There is a risk of side effects: infection (21.1%) and chest pain (10.5%). TNF inhibitor allows a significant corticosteroid-sparring effect in patients with a cardiac sarcoidosis refractory to immu• nosuppressant.