Anti‐TNF Drug‐Induced Sarcoidosis in Inflammatory Bowel Diseases: Multicentric Case Series and Literature Review
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Introduction Sarcoidosis is an inflammatory granulomatous condition and presents overlapping features with inflammatory bowel disease (IBD). Anti‐TNF treatment has revolutionized the management of several conditions, including IBD and sarcoidosis. Yet, anti‐TNF drugs have been associated with drug‐induced sarcoidosis reaction (DISR). sec-0001 Methods This is a retrospective, international, multicentric case series, including IBD patients with anti‐TNF–related DISR. A literature review was performed to identify previously published cases. sec-0002 Results Nine new cases of anti‐TNF–related DISR in IBD are described with a long follow‐up (median 45 months). After literature review, a total of 26 cases were identified. The diagnosis required histological evidence of granulomas in involved organs in all patients. Most patients had a diagnosis of Crohn′s disease (= 19, 73.1%). The culprit drug was infliximab in 15 (57.7%) and adalimumab in 11 (42.3%). The median time to sarcoidosis development was 21 months. Compared to conventional sarcoidosis, extrathoracic involvement was more prevalent (= 20, 76.7%). Management of DISR consisted of discontinuing anti‐TNF treatment in 20 cases (76.9%) and providing specific treatment in 17 cases (65.4%), with favorable outcomes in all cases. sec-0003 Conclusion Despite its rarity, DISR may be challenging for IBD patients. Discontinuation of anti‐TNF treatment is recommended, and specific treatment is required for moderate‐to‐severe cases. sec-0
Abstract
Introduction Sarcoidosis is an inflammatory granulomatous condition and presents overlapping features with inflammatory bowel disease (IBD). Anti‐TNF treatment has revolutionized the management of several conditions, including IBD and sarcoidosis. Yet, anti‐TNF drugs have been associated with drug‐induced sarcoidosis reaction (DISR). sec-0001 Methods This is a retrospective, international, multicentric case series, including IBD patients with anti‐TNF–related DISR. A literature review was performed to identify previously published cases. sec-0002 Results Nine new cases of anti‐TNF–related DISR in IBD are described with a long follow‐up (median 45 months). After literature review, a total of 26 cases were identified. The diagnosis required histological evidence of granulomas in involved organs in all patients. Most patients had a diagnosis of Crohn′s disease (= 19, 73.1%). The culprit drug was infliximab in 15 (57.7%) and adalimumab in 11 (42.3%). The median time to sarcoidosis development was 21 months. Compared to conventional sarcoidosis, extrathoracic involvement was more prevalent (= 20, 76.7%). Management of DISR consisted of discontinuing anti‐TNF treatment in 20 cases (76.9%) and providing specific treatment in 17 cases (65.4%), with favorable outcomes in all cases. sec-0003 Conclusion Despite its rarity, DISR may be challenging for IBD patients. Discontinuation of anti‐TNF treatment is recommended, and specific treatment is required for moderate‐to‐severe cases. sec-0004