Thery-Casari Clémence, Jamilloux Yvan, Bouvry Diane, Chapelon-Abric Catherine, Marquet Alicia, Bielefeld Philip, Schleinitz Nicolas, Vukusic Sandra, Girszyn Nicolas, Fain Olivier, Bonnet Fabrice, Valeyre Dominique, Seve Pascal
Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France, Université Claude Bernard Lyon 1, Villeurbanne, France.
Service de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, Bobigny, France.
Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(4):371-375. doi: 10.36141/svdld.v35i4.6999. Epub 2020 Mar 9.
Tumor necrosis factor (TNF) antagonists have been reported as an efficient third-line therapy for sarcoidosis but there is no data regarding patients who do not respond to this treatment. To report the characteristics, the outcome and the response to therapy of patients with sarcoidosis resistant to TNF antagonists. Patients from the French STAT (Sarcoidosis Treatment with Anti-TNF) registry who were classified as non-responders and who were followed-up for >1 year were included. The response to further therapies was classified as complete response, or partial response, and the others were classified as non-responders. Among the 132 patients from the registry, 14 were considered as non-responders to anti-TNF. Nine patients (66% of women; mean age 48 years) were analyzed. The mean number of organs involved was 4.2. Seven patients were previously treated with more than 2 immunosuppressive treatments. The mean duration of the anti-TNF treatment was 9 months (range, 3-24). After a mean follow-up duration of 58 months (median, 35; range, 19-128) a complete response was observed in 2/9 cases, a partial response in 5/9 cases, and 2/9 cases were considered as non-responders. In all but one patient, the immunosuppressant that allowed the clinical response had previously been used. Furthermore, the dosage was not necessarily increased to gain efficacy. Non-responders were treated by corticosteroids only because of their comorbidities or noncompliance. In patients who do not respond to TNF antagonists, previously used immunosuppressants may be useful. Excluding a differential diagnosis, assessing compliance and testing for anti-drug antibodies should be systematic. .
肿瘤坏死因子（TNF）拮抗剂已被报道为结节病的一种有效三线治疗方法，但对于对此治疗无反应的患者尚无相关数据。报告对TNF拮抗剂耐药的结节病患者的特征、结局及治疗反应。纳入法国STAT（抗TNF治疗结节病）登记处中被分类为无反应者且随访时间超过1年的患者。对进一步治疗的反应分为完全缓解或部分缓解，其他则分类为无反应者。在登记处的132例患者中，14例被认为对抗TNF无反应。分析了9例患者（66%为女性；平均年龄48岁）。受累器官的平均数量为4.2个。7例患者先前接受过2种以上免疫抑制治疗。抗TNF治疗的平均持续时间为9个月（范围3 - 24个月）。平均随访58个月（中位数35个月；范围19 - 128个月）后，9例中有2例观察到完全缓解，5例部分缓解，2例被认为无反应。除1例患者外，所有实现临床反应的患者此前均使用过免疫抑制剂。此外，不一定通过增加剂量来提高疗效。无反应者仅因其合并症或不依从性而接受皮质类固醇治疗。对于对抗TNF拮抗剂无反应的患者，先前使用过的免疫抑制剂可能有用。应系统地排除鉴别诊断、评估依从性并检测抗药物抗体。
