[Skip to Content]
[Skip to Content Landing]
Brief Report
July 2017

Efficacy and Tolerance of Anti–Tumor Necrosis Factor α Agents in Cutaneous SarcoidosisA French Study of 46 Cases

Author Affiliations
  • 1Department of Dermatology, AP-HP Hôpital Henri Mondor, Créteil, France
  • 2Department of Dermatology, EA 7379 – EpiDermE, Université Paris Est, Créteil, France
  • 3Department of Internal Medicine, Hôpital de la Croix-Rousse, Lyon, France
  • 4Department of Internal Medicine, APHP Hôpital Henri Mondor, Créteil, France
  • 5Department of Dermatology, Hôpital Saint-Eloi, Montpellier, France
  • 6Department of Internal Medicine, Centre hospitalier universitaire de Grenoble-Alpes, Grenoble, France
  • 7Department of Dermatology, APHP Hôpital Avicenne, Bobigny, France
  • 8Department of Internal Medicine, APHP Hôpital de la Pitié-Salpêtrière, Paris, France
  • 9Department of Dermatology, Centre hospitalier Lyon-Sud, Lyon, France
  • 10Department of Dermatology, Hôpital Claude Huriez, Lille, France
  • 11Department of Dermatology, Hôpital Charles Nicolle, Rouen, France
  • 12Department of Internal Medicine, APHP Hôpital Saint-Antoine, Paris, France
  • 13Department of Pneumology, Hôpital Bretonneau, Tours, France
  • 14Department of Dermatology, APHP Hôpital Tenon, Paris, France
  • 15Department of Internal Medicine, APHP Hôpital Bicêtre Le Kremlin-Bicêtre, France
  • 16Department of Dermatology, Hôpital de l’Archet, Nice, France
  • 17Department of Internal Medicine, Hôpital Estaing, Clermont-Ferrand, France
  • 18Department of Internal Medicine, Hôpital Saint-Joseph, Marseille, France
  • 19Department of Pneumology, APHP Hôpital Avicenne, Bobigny, France
  • 20Department of Dermatology, Université Paris Est UPEC, Créteil, France
JAMA Dermatol. 2017;153(7):681-685. doi:10.1001/jamadermatol.2017.1162
Key Points

Question  What is the long-term efficacy and safety of anti–tumor necrosis factor α agents (anti-TNF) in treating cutaneous sarcoidosis?

Findings  In this multicenter observational study of 46 patients with sarcoidosis and skin involvement who were treated with anti-TNF, the overall cutaneous response rate was 24% after 3 months, 46% after 6 months, and 79% after 12 months. Eleven (24%) patients stopped anti-TNF because of adverse events, and patients treated for visceral involvement had significantly more infections (48% vs 9.5%), and relapses occurred in half of the patients after discontinuation of anti-TNF.

Meaning  Anti-TNF agents are effective against cutaneous sarcoidosis with a low infectious rate in patients treated for skin involvement.

Abstract

Importance  Evidence for the long-term efficacy and safety of anti–tumor necrosis factor α agents (anti-TNF) in treating cutaneous sarcoidosis is lacking.

Objective  To determine the efficacy and safety of anti-TNF in treating cutaneous sarcoidosis in a large observational study.

Design, Setting, and Participants  STAT (Sarcoidosis Treated with Anti-TNF) is a French retrospective and prospective multicenter observational database that receives data from teaching hospitals and referral centers, as well as several pneumology, dermatology, and internal medicine departments. Included patients had histologically proven sarcoidosis and received anti-TNF between January 2004 and January 2016. We extracted data for patients with skin involvement at anti-TNF initiation.

Main Outcomes and Measures  Response to treatment was evaluated for skin and visceral involvement using the ePOST (extra-pulmonary Physician Organ Severity Tool) severity score (from 0 [not affected] to 6 [very severe involvement]). Epidemiological and cutaneous features at baseline, efficacy, steroid-sparing, safety, and relapses were recorded. The overall cutaneous response rate (OCRR) was defined as complete (final cutaneous ePOST score of 0 or 1) or partial response (ePOST drop ≥2 points from baseline but >1 at last follow-up).

Results  Among 140 patients in the STAT database, 46 had skin involvement. The most frequent lesions were lupus pernio (n = 21 [46%]) and nodules (n = 20 [43%]). The median cutaneous severity score was 5 and/or 6 at baseline. Twenty-one patients were treated for skin involvement and 25 patients for visceral involvement. Reasons for initiating anti-TNF were failure or adverse effects of previous therapy in 42 patients (93%). Most patients received infliximab (n = 40 [87%]), with systemic steroids in 28 cases (61%) and immunosuppressants in 32 cases (69.5%). The median (range) follow-up was 45 (3-103) months. Of the 46 patients with sarcoidosis and skin involvement who were treated with anti-TNF were included, median (range) age was 50 (14-78) years, and 33 patients (72%) were women. The OCRR was 24% after 3 months, 46% after 6 months, and 79% after 12 months. Steroid sparing was significant. Treatment was discontinued because of adverse events in 11 patients (24%), and 21 infectious events occurred in 14 patients (30%). Infections were more frequent in patients treated for visceral involvement than in those treated for skin involvement (n = 12 of 25 [48%] vs n = 2 of 21 [9.5%], respectively; P = .02). The relapse rate was 44% 18 months after discontinuation of treatment. Relapses during treatment occurred in 35% of cases, mostly during anti-TNF or concomitant treatment tapering.

Conclusions and Relevance  Anti-TNF agents are effective but suspensive in cutaneous sarcoidosis. The risk of infectious events must be considered.

×