Full Papers
Use of third-line therapies in advanced sarcoidosis
E.E. Lower1, M. Sturdivant2, L. Grate3, R.P. Baughman4
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH, USA.
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA. bob.baughman@uc.edu
CER12498
2020 Vol.38, N°5
PI 0834, PF 0840
Full Papers
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PMID: 31820728 [PubMed]
Received: 12/06/2019
Accepted : 16/09/2019
In Press: 20/11/2019
Published: 02/10/2020
Abstract
OBJECTIVES:
Patients with advanced sarcoidosis often require third-line therapies including infliximab, adalimumab, rituximab, and repository corticotropin injection (RCI). Over time, some patients discontinue therapy.
METHODS:
In a retrospective review of patients at the University of Cincinnati Sarcoidosis Clinic, we identified patients who received one or more third-line treatments. Age, race, gender, organ involvement, and initial date of therapy were collected. For patients in whom a drug was discontinued, the last date of treatment, reason for drug discontinuation, and outcome of drug withdrawal were noted.
RESULTS:
Of the 2109 patients identified, 317 (15%) had received one or more third-line therapies (infliximab: 258 patients; adalimumab: 52 patients; rituximab: 34 patients; RCI: 101 patients). Patients with neurologic, cutaneous, or ocular sarcoidosis involvement were more likely to have received third-line therapy. Overall, 225 (50.6%) of treatment regimens were discontinued. Rate of discontinuation was higher for infliximab (55%), adalimumab (58%), or RCI (43%) than for rituximab (29%, Chi square=11.959, p=0.0075). Compared to RCI, the hazard ratio (HR) for discontinuing therapy due to infection was increased for infliximab (HR=12.14, p=0.0134) and adalimumab (HR=9.71, p=0.0356). The hazard ratio was higher for drug discontinuation due to allergic reactions to infliximab (HR=9.40, p=0.0017) or adalimumab (HR=5.83, p=0.0273). For patients receiving at least two years of therapy, drug survival was significantly shorter for infliximab compared to other therapies (Chi square=5.4054, p=0.0201).
CONCLUSIONS:
While third-line therapies are often initially effective, a significant number of patients discontinued individual treatments and initiated an alternative third-line therapy.
