Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Semin Arthritis Rheum. 2019 Jun;48(6):1093-1104. doi: 10.1016/j.semarthrit.2018.10.005. Epub 2018 Oct 16.
Though anti-tumor necrosis factor agents (anti-TNFs) have been recommended as third-line therapy for sarcoidosis, an up-to-date systematic synthesis of their efficacy and safety is lacking.
To systematically review the literature to characterize the efficacy and safety of anti-TNFs in sarcoidosis.
All countries and treatment settings were included.
We searched MEDLINE, EMBASE, CINAHL, Web of Science, ClinicalTrials.gov, Cochrane Library, and Google Scholar from inception to November 27, 2017. Studies of five or more cases of sarcoidosis treated with anti-TNFs were included. Descriptive statistics were performed.
Sixty-five studies (including five randomized controlled trials [RCTs]) were identified, comprising 1525 patients. For pulmonary sarcoidosis, one RCT found infliximab (IFX) significantly improved vital capacity vs. placebo; a second detected no difference. In non-randomized studies, IFX improved pulmonary function in 79% of patients. For cutaneous sarcoidosis, compared to placebo, adalimumab (ADA) showed greater Physician Global Assessment response and significantly reduced target lesion area, and IFX significantly decreased Sarcoidosis Area and Severity Index induration and erythema scores. In non-randomized studies of cutaneous, ocular, neurologic, and multisystem sarcoidosis, IFX improved 89%, 69%, 77%, and 71% of cases, respectively. ADA improved 77% of ocular sarcoidosis cases. IFX displayed a steroid-sparing effect. Half of patients relapsed after discontinuation of IFX, ADA, etanercept, or certolizumab pegol. In RCTs, compared to placebo, anti-TNFs had comparable overall and serious adverse events and slightly more serious infections.
Available evidence suggests the efficacy and safety of IFX in pulmonary, cutaneous, ocular, neurologic, and multisystem sarcoidosis, and ADA in cutaneous and ocular sarcoidosis.
尽管抗肿瘤坏死因子制剂（anti-TNFs）已被推荐为结节病的三线治疗药物，但缺乏对其疗效和安全性的最新系统综合评估。
系统回顾文献，评估抗 TNF 制剂治疗结节病的疗效和安全性。
所有国家和治疗环境均被纳入。
我们检索了 MEDLINE、EMBASE、CINAHL、Web of Science、ClinicalTrials.gov、Cochrane 图书馆和 Google Scholar，检索时间截至 2017 年 11 月 27 日。纳入了使用抗 TNF 制剂治疗 5 例及以上结节病患者的研究。采用描述性统计方法。
共确定了 65 项研究（包括 5 项随机对照试验[RCT]），共纳入 1525 例患者。对于肺结节病，1 项 RCT 发现英夫利昔单抗（IFX）显著改善了肺活量，优于安慰剂；另一项 RCT 则未发现差异。在非随机研究中，IFX 改善了 79%患者的肺功能。对于皮肤结节病，与安慰剂相比，阿达木单抗（ADA）显示出更大的医生整体评估反应，且显著减少了靶病变面积，而 IFX 则显著降低了结节病面积和严重程度指数硬结和红斑评分。在皮肤、眼、神经和多系统结节病的非随机研究中，IFX 分别改善了 89%、69%、77%和 71%的病例，ADA 改善了 77%的眼结节病病例。IFX 具有类固醇节省效应。50%的患者在停止使用 IFX、ADA、依那西普或 Certolizumab pegol 后复发。在 RCT 中，与安慰剂相比，抗 TNF 制剂的总不良反应和严重不良反应发生率相当，感染更为严重。
现有证据表明 IFX 对肺、皮肤、眼、神经和多系统结节病以及 ADA 对皮肤和眼结节病的疗效和安全性。
