Case Report: TNFα Antagonists Are an Effective Therapy in Cardiac Sarcoidosis

Introduction: Cardiac sarcoidosis (CS) is a life-threatening disease in which clear recommendations are lacking. We report a case series of CS successfully treated by tumor necrosis factor (TNF)alpha antagonists. Methods: We conducted a single-center retrospective study of our patients with CS treated by TNF alpha antagonists. Results: Four cases (4/84, 4.7%) were found in our database. Mean age was 40 years (range 34-53 years), and all were Caucasian men. Mean follow-up was 54.75 months (range 25-115 months). All patients received corticosteroid therapy (CT) and immunosuppressive therapy (IT). TNF alpha antagonists (infliximab or adalimumab) were started after the first or second CS relapse under CT and IT. One patient experienced relapse under TNF alpha antagonists (isolated decreased left ventricular ejection) and responded to a shorter interval of TNF alpha antagonist infusion. CT was discontinued in three patients treated with TNF alpha antagonists without relapse or major cardiac events during follow-up. No serious adverse event occurred in our case series, possibly due to dose sparing and frequent arrest of CT. Conclusion: TNF alpha antagonists were effective in refractory and/or relapsing CS treated by corticosteroids and/or immunosuppressive agents, without serious adverse events, and should be considered earlier in CS treatment scheme.

Automated summary

This study reviewed a case series of cardiac sarcoidosis treated with TNF alpha antagonists, showing that adding TNF alpha antagonists to corticosteroid and immunosuppressive therapy can reduce relapse and major cardiac events without serious adverse events.