MONTPELIER, France—Sarcoid-like granulomas are a new adverse effect of all TNF-blockers, suggests a new report published in Rheumatology.1

”Sarcoid-like granulomatosis is rare but not exceptional in patients treated with TNF blockers...and does not seem to be related to gender, rheumatic disease or in our series the type of anti-TNF drug used.”—Claire Immediato Daïen, MD
“Sarcoid-like granulomatosis is rare but not exceptional in patients treated with TNF blockers (approximately 1/2800) and does not seem to be related to gender, rheumatic disease or in our series the type of anti-TNF drug used (monoclonal antibodies or soluble receptor),” concluded the researchers, who were led by Claire Immediato Daïen, MD, of Le Centre Hospitalier Universitaire CHU CHR de Montpellier in Montpelier, France. The good news is that discontinuation of anti-TNF usually leads to recovery.

Variety of TNF inhibitors, indications associated with sarcoidosis

The new report provides data on the largest series yet of patients diagnosed with sarcoidosis during anti-TNF therapy, focused on 10 patients. Of these, 5 were treated with etanercept and 5 with monoclonal antibodies. Four patients received TNF blockers for RA, and 6 received the biologic therapy to treat spondyloarthritides (SpA).

Median time from beginning of therapy to granulomatosis diagnosis was 18 months. Patients mainly reported pulmonary and cutaneous symptoms, and angiotensin-converting enzyme activity was increased in 6 patients. Eight patients in the study showed lymph-node and/or lung involvement on chest CT scan.

The researchers said that about 6 months were required for the clinical, biological and x-ray signs of sarcoidosis to remit after TNF blockade was stopped. All patients improved following drug discontinuation regardless of whether they used steroids.

Translating research into practice: What to do if sarcoidosis develops

“When anti-TNF therapy is required to control rheumatic disease, a switch from a soluble receptor format to monoclonal antibodies and the converse could be recommended,” the researchers conclude. “However, relapse could occur even after a switch.”

Reference
1. Daïen CI, Monnier A, Claudepierre P, et al. Sarcoid-like granulomatosis in patients treated with tumor necrosis favor blockers: 10 cases. Rheumatology.2009;48:883-886.