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Risk factors of relapse in pulmonary sarcoidosis treated with corticosteroids. Clin Rheumatol 2019; 38:1993-1999. [PMID: 30877493 DOI: 10.1007/s10067-019-04507-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/17/2019] [Accepted: 03/05/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the incidence and risk factors of relapse in pulmonary sarcoidosis treated with corticosteroids. METHODS Medical records of patients with pulmonary sarcoidosis were retrospectively reviewed. Clinical features, chest radiographs, pulmonary function tests, and treatment information were collected. The starting point was the date of diagnosis. Clinical relapse was defined as chest high-resolution computed tomography (HRCT) showing radiographic progression in combination of worsening of clinical symptoms to warrant retreatment following a decrease in dose or discontinuation of corticosteroids, without alternative causes such as infections, heart failure, or pulmonary embolism. Non-relapse was defined as remission of clinical symptoms and chest abnormalities, or clinical syndrome improvement with retention or stability of radiographic abnormalities after corticosteroids were withdrawn for at least 6 months. The primary endpoint was the occurrence of relapse. RESULTS Two hundred three patients with newly biopsy-proven pulmonary sarcoidosis were enrolled over a 7-year period. Among them, 96 patients received corticosteroids therapy. Relapse occurred in 30 patients with the relapse rate yielding 30/96 (31.25%). After adjustment, multivariate analysis showed that smoking history (HR = 3.674 95% CI 1.573-8.581, P = 0.003) and increased percentages of circulating neutrophils (> 70%) (HR = 2.211, 95% CI 1.073-4.557, P = 0.032) were the significant predictors of relapse in pulmonary sarcoidosis treated with corticosteroids. CONCLUSIONS This study provided useful information that the relapse and associated risk factors should be taken into considerations when determining treatment strategies for patients with pulmonary sarcoidosis.
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Karampitsakos T, Vraka A, Bouros D, Liossis SN, Tzouvelekis A. Biologic Treatments in Interstitial Lung Diseases. Front Med (Lausanne) 2019; 6:41. [PMID: 30931306 PMCID: PMC6425869 DOI: 10.3389/fmed.2019.00041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/13/2019] [Indexed: 12/17/2022] Open
Abstract
Interstitial lung diseases (ILD) represent a group of heterogeneous parenchymal lung disorders with complex pathophysiology, characterized by different clinical and radiological patterns, ultimately leading to pulmonary fibrosis. A considerable proportion of these disease entities present with no effective treatment, as current therapeutic regimens only slow down disease progression, thus leaving patients, at best case, with considerable functional disability. Biologic therapies have emerged and are being investigated in patients with different forms of ILD. Unfortunately, their safety profile has raised many concerns, as evidence shows that they might cause or exacerbate ILD status in a subgroup of patients. This review article aims to summarize the current state of knowledge on their role in patients with ILD and highlight future perspectives.
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Affiliation(s)
- Theodoros Karampitsakos
- 5th Department of Pneumonology, General Hospital for Thoracic Diseases Sotiria, Athens, Greece
| | - Argyro Vraka
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, Sotiria Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, Sotiria Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatis-Nick Liossis
- Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - Argyris Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, Sotiria Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Differential Diagnosis of Asthma. ALLERGY AND ASTHMA 2019. [PMCID: PMC7123211 DOI: 10.1007/978-3-030-05147-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Asthma is one of the most common chronic syndromes worldwide (Moorman et al., Vital Health Stat 3(35), 2012). It is not a diagnosis but a clinical syndrome based on a constellation of signs and symptoms (Li et al., Ann Allergy Asthma Immunol 81:415–420(IIa), 1998). The classic symptoms of asthma include chest tightness, wheeze, cough, and dyspnea (Moorman et al., Vital Health Stat 3(35), 2012). The term asthma encompasses a spectrum of pulmonary diseases sharing the hallmark of reversible airway obstruction and can be classified as allergic or non-allergic (Löwhagen, J Asthma. 52(6):538–44, 2015). Asthma designated allergic is due to an immunoglobulin E (IgE)-mediated process, but as noted not all asthma is allergic in etiology (Romanet-Manent et al., Allergy 57:607–13, 2002). The differential diagnosis for asthma is broad and requires a detailed history with supportive pulmonary function tests to be properly diagnosed.
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Schouten J, Beach J, Burstyn I, Senthilselvan A, Cherry N. Is Farm Milk a Risk Factor for Sarcoidosis? The Role of Farm Residence, Unpiped Water and Untreated Milk in Sarcoidosis: A Case-Referent Study in Alberta, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122755. [PMID: 30563171 PMCID: PMC6313709 DOI: 10.3390/ijerph15122755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
Objective: Sarcoidosis is thought to be an aberrant immune response to environmental agents, with rural living as a risk factor. We aimed to determine if farm living, consumption of farm (untreated) milk, or untreated water increased the risk of sarcoidosis. Methods: In a case-referent design, patients aged 18–60 with pulmonary sarcoidosis together with referents with other chronic respiratory disease, diagnosed 1999–2005 in Alberta, Canada, were approached through their specialist physician. Participants completed a telephone questionnaire about farm living, use of untreated water and farm milk for each residence from birth to diagnosis. Exposures at birth, up to age five, and up to diagnosis were calculated. Results: The study included 615 cases and 1334 referents. The consumption of farm milk, but not of unpiped water or farm living overall, appeared to be consistently associated with sarcoidosis in a fully adjusted analysis. The association was present for farm milk used in the residence of birth (odds ratios (OR): 1.59, 95% confidence intervals (CI): 1.08–2.34) and persisted for those drinking farm milk to age five years (OR: 1.52, 95% CI: 1.04–2.21), and for those drinking farm milk for >16 years to diagnosis (OR: 1.50, 95% CI: 1.04–2.15). The association with sarcoidosis was stronger when the referent was in the subgroup diagnosed with asthma but was present also with referents with other chronic respiratory disease. Among those whose family used farm milk at birth and to age 5 years, continued use of farm milk into adulthood increased the risk of sarcoidosis. Conclusion: We observed evidence of positive association between consumption of farm milk and sarcoidosis.
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Affiliation(s)
- Janine Schouten
- Faculty of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada.
| | - Jeremy Beach
- Faculty of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada.
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
| | | | - Nicola Cherry
- Faculty of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada.
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Abstract
INTRODUCTION Treatment of sarcoidosis recommendations are often based on clinical experience and expert opinion. However, there are an increasing number of studies which are providing evidence to support decisions regarding treatment. Areas covered: Several studies have identified factors associated with increased risk for organ failure or death ('danger'). There have been several studies focused on the role of treatment to improve quality of life for the patient. Sarcoidosis treatment often follows a progression, based on response. Corticosteroids remain the initial treatment of choice for most patients. Second-line therapy includes cytotoxic agents. Immunosuppressives such as methotrexate, azathioprine, leflunomide, and mycophenolate have all been reported as effective in sarcoidosis. Biologics and other agents are third-line therapy. The monoclonal antibodies directed against tumor necrosis factor have been shown to be particularly effective for advanced disease. Infliximab has been the most studied drug in this class. Newer treatments, including repository corticotropin injection and rituximab have been reported as effective in some cases. Expert commentary: In this review, we use the GRADE system to evaluate the currently available evidence and make recommendations regarding treatment.
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Affiliation(s)
- W Ennis James
- a Division of Pulmonary and Critical Care , Medical University of South Carolina , Charleston , SC , USA
| | - Robert Baughman
- b Department of Medicine , University of Cincinnati Medical Center , Cincinnati , OH , USA
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Abstract
INTRODUCTION In sarcoidosis, muscle involvement is common, but mostly asymptomatic. Currently, little is known about respiratory muscle and diaphragm involvement and function in patients with sarcoidosis. Reduced inspiratory muscle strength and/or a reduced diaphragm function may contribute to exertional dyspnea, fatigue and reduced health-related quality of life. Previous studies using volitional and non-volitional tests demonstrated a reduced inspiratory muscle strength in sarcoidosis compared to control subjects, and also showed that respiratory muscle function may even be significantly impaired in a subset of patients. Areas covered: This review examines the evidence on respiratory muscle involvement and its implications in sarcoidosis with emphasis on pathogenesis, diagnosis and treatment of respiratory muscle dysfunction. The presented evidence was identified by a literature search performed in PubMed and Medline for articles about respiratory and skeletal muscle function in sarcoidosis through to January 2018. Expert commentary: Respiratory muscle involvement in sarcoidosis is an underdiagnosed condition, which may have an important impact on dyspnea and health-related quality of life. Further studies are needed to understand the etiology, pathogenesis and extent of respiratory muscle involvement in sarcoidosis.
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Affiliation(s)
- Tina Schreiber
- a Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Faculty of Health/School of Medicine , Witten/Herdecke University , Cologne , Germany
| | - Wolfram Windisch
- a Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Faculty of Health/School of Medicine , Witten/Herdecke University , Cologne , Germany
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Spagnolo P, Rossi G, Trisolini R, Sverzellati N, Baughman RP, Wells AU. Pulmonary sarcoidosis. THE LANCET RESPIRATORY MEDICINE 2018; 6:389-402. [DOI: 10.1016/s2213-2600(18)30064-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 12/14/2022]
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Efficacy and safety of infliximab biosimilar Inflectra® in severe sarcoidosis. Respir Med 2018; 138S:S7-S13. [DOI: 10.1016/j.rmed.2018.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 02/08/2023]
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Abstract
PURPOSE OF REVIEW A number of recent studies have explored the possibility to apply personalized medicine to interstitial lung diseases (ILDs), particularly idiopathic pulmonary fibrosis (IPF), the most common and deadly of the idiopathic interstitial pneumonias. In our review, we summarize and discuss the most recent literature on personalized medicine in IPF as well as hypersensitivity pneumonitis and sarcoidosis, with emphasis on patient subgroups for which a personalized approach to disease prognostication and management may become a reality in the near future. RECENT FINDINGS Most of the studies that have explored the applicability of personalized medicine to ILDs have been conducted in patients with IPF. Such studies have suggested the existence of several distinct disease subgroups defined by similar genetic profiles, molecular pathways, exposures and individual lifestyles. Personalized medicine in hypersensitivity pneumonitis is in its infancy. The development and applicability of personalized medicine to sarcoidosis, on the other hand, remains problematic for several reasons, including the lack of a diagnostic gold standard, the highly variable and unpredictable disease course, particularly across patients of different ethnicities, the poor correlation between disease activity and disease severity and the lack of a validated management algorithm. SUMMARY A number of distinct patient subgroups have been identified in ILDs. Although available data need to be validated longitudinally, the possibility to study homogeneous groups of patients may allow prediction of disease behavior and response to treatment with dramatic clinical implications.
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Broos CE, Koth LL, van Nimwegen M, in ‘t Veen JC, Paulissen SM, van Hamburg JP, Annema JT, Heller-Baan R, Kleinjan A, Hoogsteden HC, Wijsenbeek MS, Hendriks RW, van den Blink B, Kool M. Increased T-helper 17.1 cells in sarcoidosis mediastinal lymph nodes. Eur Respir J 2018; 51:13993003.01124-2017. [DOI: 10.1183/13993003.01124-2017] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/02/2018] [Indexed: 11/05/2022]
Abstract
The lung-draining mediastinal lymph nodes (MLNs) are currently widely used to diagnose sarcoidosis. We previously reported that T-helper (Th) 17.1 cells are responsible for the exaggerated interferon-γ production in sarcoidosis lungs. In this study, we aimed to investigate 1) whether Th17.1 cells are also increased in the MLNs of sarcoidosis patients and 2) whether frequencies of the Th17.1 cells at diagnosis may correlate with disease progression.MLN cells from treatment-naive pulmonary sarcoidosis patients (n=17) and healthy controls (n=22) and peripheral blood mononuclear cells (n=34) and bronchoalveolar lavage fluid (BALF) (n=36) from sarcoidosis patients were examined for CD4+ T-cell subset proportions using flow cytometry.Higher proportions of Th17.1 cells were detected in sarcoidosis MLNs than in control MLNs. Higher Th17.1 cell proportions were found in sarcoidosis BALF compared with MLNs and peripheral blood. Furthermore, BALF Th17.1 cell proportions were significantly higher in patients developing chronic disease than in patients undergoing resolution within 2 years of clinical follow-up.These data suggest that Th17.1 cell proportions in pulmonary sarcoidosis can be evaluated as a diagnostic and/or prognostic marker in clinical practice and could serve as a new therapeutic target.
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Prasse A. The Diagnosis, Differential Diagnosis, and Treatment of Sarcoidosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:565-74. [PMID: 27598883 DOI: 10.3238/arztebl.2016.0565] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sarcoidosis is a granulomatous inflammatory disease of unknown cause. Its prevalence in Germany is approximately 46 per 100 000 persons. METHODS This article is based on pertinent publications retrieved by a selective search in PubMed. RESULTS A presumptive diagnosis of sarcoidosis is made in any patient with a granulomatous inflammation that is not explained by any other identifiable cause, such as an infection or foreign body. Non-caseating granulomas containing epithelioid cells are its histological hallmark. Recently developed diagnostic techniques, including positron emission tomography and magnetic resonance imaging, have made it easier to detect organ involvement and to assess the activity of the disease. The pattern of organ involvement varies from patient to patient. Many patients have a systemic inflammatory reaction with subfebrile or febrile temperatures, night sweats, weight loss, diminished physical reserve, and fatigue. Sarcoidosis often resolves spontaneously. Detection of organ involvement is not necessarily an indication for treatment, but treatment is clearly needed if there is symptomatic cardiac involvement or any involvement of the central nervous system. Oral corticosteroids are the first line of treatment. Their long-term use can cause serious complications. CONCLUSION The treatment of patients with sarcoidosis, particularly those with complicated disease courses, requires close collaboration of the primary care physician with a specialized interdisciplinary center.
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Affiliation(s)
- Antje Prasse
- Clinic for Pneumology, Hannover Medical School; Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover; German Center for Lung Research, DZL BREATH, Hannover
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Tramper J, Nossent EJ, Lely RJ, Krouwels FH, Meijboom LJ, Vonk Noordegraaf A. Balloon pulmonary angioplasty in sarcoid-related pulmonary hypertension. Eur Respir J 2018; 51:51/1/1701502. [DOI: 10.1183/13993003.01502-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/26/2017] [Indexed: 11/05/2022]
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T-cell immunology in sarcoidosis: Disruption of a delicate balance between helper and regulatory T-cells. Curr Opin Pulm Med 2017; 22:476-83. [PMID: 27379969 DOI: 10.1097/mcp.0000000000000303] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Although the aetiology of sarcoidosis is not yet completely understood, immunological changes within the T-cell compartment are characteristic for an exaggerated antigen-driven immune response. In this review, we describe the most recent findings on T-cell subset responses and regulation in sarcoidosis. We discuss how future immunological research can advance the field to unravel pathobiological mechanisms of this intriguingly complex disease. RECENT FINDINGS Research into the field of T-cell plasticity has recently challenged the long-held T helper type 1 (Th1) paradigm in sarcoidosis and striking parallels with autoimmune disorders and common variable immunodeficiency were recognized. For instance, it was demonstrated that Th17.1-cells rather than Th1-cells are responsible for the exaggerated IFN-γ production in pulmonary sarcoidosis. Furthermore, impaired regulatory T-cell function and alterations within the expression of co-inhibitory receptors that control T-cell responses, such as PD-1, CTLA-4 and BTNL2, raise new questions regarding T-cell regulation in pulmonary sarcoidosis. SUMMARY It becomes increasingly clear that Th17(.1)-cells and regulatory T-cells are key players in sarcoidosis T-cell immunology. New findings on plasticity and co-inhibitory receptor expression by these subsets help build a more comprehensive model for T-cell regulation in sarcoidosis and will finally shed light on the potential of new treatment modalities.
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a chronic granulomatous disease typically affecting the lung, lymph nodes, and other organ systems. Evidence suggests that the morbidity and mortality rates for sarcoidosis in the USA are rising, despite widespread use of anti-inflammatory therapies. In this review, we survey new therapies that target specific inflammatory pathways in other diseases (such as rheumatoid arthritis, Crohn's disease, and psoriasis) that are similar to pathways relevant to sarcoidosis immunopathogenesis, and therefore, represent potentially new sarcoidosis therapies. RECENT FINDINGS Immunopathogenesis of sarcoidosis has been well elucidated over the past few years. There is abundant evidence for T-cell activation in sarcoidosis leading to activation of both Th1 and Th17 inflammatory cascades. Therapies targeting T-cell activation, Th1 pathways (such as the interleukin-6 inhibitors), Th17 pathway mediators, and others have been Food and Drug Administration approved or under investigation to treat a variety of autoimmune inflammatory diseases, but have not been studied in sarcoidosis. Targeting the p38 mitogen-activated protein kinases and the ubiquitine proteasome system with new agents may also represent a novel therapeutic option for patients with sarcoidosis. SUMMARY Rising morbidity and mortality rates for patients with sarcoidosis strongly support the need to develop more effective anti-inflammatory therapies to treat chronic disease.
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Broos CE, Poell LHC, Looman CWN, In 't Veen JCCM, Grootenboers MJJH, Heller R, van den Toorn LM, Wapenaar M, Hoogsteden HC, Kool M, Wijsenbeek MS, van den Blink B. No evidence found for an association between prednisone dose and FVC change in newly-treated pulmonary sarcoidosis. Respir Med 2017; 138S:S31-S37. [PMID: 29137908 DOI: 10.1016/j.rmed.2017.10.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/20/2017] [Accepted: 10/27/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Prednisone is used as first-line therapy for pulmonary sarcoidosis. What dosing strategy has the best balance between effect and side-effects is largely unknown. We analyzed change in forced vital capacity (FVC) and weight during different prednisone doses used in daily practice for treatment naïve pulmonary sarcoidosis patients. METHODS Multilevel models were used to describe FVC and weight change over time. Correlations were calculated using linear regression models. RESULTS Fifty-four patients were included. FVC changed over time (p < 0.001), with an average increase of 9.6% predicted (95% CI: 7.2 to 12.1) at 12 months. Weight changed significantly over time (p < 0.001), with an average increase of 4.3 kg (95% CI: 3.0 to 5.6) at 12 months. Although FVC and weight changed significantly over time, there was little correlation between prednisone dose and FVC change, while weight increase correlated significantly with cumulative prednisone dose at 24 months. In patients treated with a high cumulative prednisone dose, baseline FVC was on average lower (p = 0.001) compared to low dose treated patients, while no significant differences were observed in need for second/third-line therapy or number of exacerbations. A strategy leading to a low cumulative dose at 12 months was defined by rapid dose tapering to 10 mg/day within 3.5 months. CONCLUSIONS These results suggest that prednisone therapy aimed at improving or preserving FVC in newly- treated pulmonary sarcoidosis can often be reduced in dose, using a treatment regimen that is characterized by early dose tapering.
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Affiliation(s)
- Caroline E Broos
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Linda H C Poell
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | - Roxane Heller
- Department of Pulmonology, Ikazia Hospital, Rotterdam, The Netherlands
| | | | - Monique Wapenaar
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Henk C Hoogsteden
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Mirjam Kool
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
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Irwin RS, Manaker S, Metersky ML, Baughman RP, Otulana T, Weinberger SE, Sussman AJ, McGrath NA. Higher Priced Older Pharmaceuticals: How Should We Respond? Chest 2017; 153:23-33. [PMID: 29017958 DOI: 10.1016/j.chest.2017.09.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 02/08/2023] Open
Abstract
We and our patients have been aware of the high cost of medications in the United States for decades; however, we are now witnessing a relatively new phenomenon: exponential price increases for some older pharmaceuticals that have been available for years. To assist practitioners in how to respond to the issue of higher priced pharmaceuticals, an interprofessional session was developed and held at CHEST 2016 in Los Angeles. The session proceedings and a few updates are presented here to summarize what pulmonologists; a sarcoidosis expert; a retired executive of a medical society, an executive of a pharmaceutical company and of a pharmacy; and an ethicist advise that we do about the problem. Because the comments presented at the session and in this manuscript represent the opinions of each author, this commentary in essence is a compilation of nine editorials. It does not represent a comprehensive discussion of the field of pricing of drugs. In reflecting upon the answers to the questions posed, and regardless of their sector of health care, all participants stated that they focused on the patient. However, actually providing patient-focused care (ie, the care defined from the patient's perspective) is another matter. To significantly improve patient satisfaction and health-care outcomes, patient-focused care needs to embody the 3 Cs of (1) communication, (2) continuity of care, and (3) concordance of expectations (ie, finding the common ground). Therefore, we discuss how the 3 Cs apply to responses to higher priced pharmaceuticals.
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Affiliation(s)
| | - Scott Manaker
- The Perelman School of Medicine and University of Pennsylvania, Philadelphia, PA
| | - Mark L Metersky
- University of Connecticut School of Medicine, Farmington, CT
| | - Robert P Baughman
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | | | - Steven E Weinberger
- The Perelman School of Medicine and University of Pennsylvania, Philadelphia, PA; Medical Education and Publishing Division, American College of Physicians, Philadelphia, PA
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Kirkil G, Lower EE, Baughman RP. Predictors of Mortality in Pulmonary Sarcoidosis. Chest 2017; 153:105-113. [PMID: 28728933 DOI: 10.1016/j.chest.2017.07.008] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The goal of this study was to assess the prognostic strength of factors in predicting respiratory death in a large cohort of patients with sarcoidosis with at least 8 years' follow-up. METHODS Data were collected on age, sex, self-declared race, time of death, spirometry findings, diffusing capacity for carbon monoxide, chest radiograph stage, extent of fibrosis on high-resolution CT (HRCT) scanning, and presence of precapillary pulmonary hypertension (PH). The Gender-Age-Physiology (GAP) index and Walsh model criteria for high vs low risk were calculated. RESULTS A total of 452 patients were identified who had complete pulmonary function testing and chest imaging. The median age at time of entry into the study was 50 years (range, 25-78 years). PH was confirmed by right heart catheterization in 29 (6.4%). Of 452 patients, 42 died during the time of the study, including 38 (8.4%) who died of sarcoidosis-associated respiratory failure and 4 who died of non-sarcoidosis causes. The overall mortality from sarcoidosis was 3.9% and 9.0% at 5 and 10 years, respectively. Alive patients were significantly younger than patients who died from sarcoidosis. Increased mortality was seen for black patients, stage 4 chest radiographs, > 20% fibrosis on HRCT scanning, or PH. The two composite scores (GAP and the Walsh model) were predictive of increased mortality according to univariate analysis. Using the Cox proportional hazards regression model, only age, extent of fibrosis on HRCT scanning, and PH were independent predictors of mortality. CONCLUSIONS Although most patients with sarcoidosis do well, increased mortality was seen in those patients who were older, had extensive fibrosis on HRCT scanning, or who had PH.
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Affiliation(s)
- Gamze Kirkil
- Department of Chest Disease, University of Firat, Elazığ, Turkey
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
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Caforio AL, Adler Y, Agostini C, Allanore Y, Anastasakis A, Arad M, Böhm M, Charron P, Elliott PM, Eriksson U, Felix SB, Garcia-Pavia P, Hachulla E, Heymans S, Imazio M, Klingel K, Marcolongo R, Matucci Cerinic M, Pantazis A, Plein S, Poli V, Rigopoulos A, Seferovic P, Shoenfeld Y, Zamorano JL, Linhart A. Diagnosis and management of myocardial involvement in systemic immune-mediated diseases: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease. Eur Heart J 2017; 38:2649-2662. [DOI: 10.1093/eurheartj/ehx321] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
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Brito-Zerón P, Pérez-Alvarez R, Pallarés L, Retamozo S, Baughman RP, Ramos-Casals M. Sarcoidosis: an update on current pharmacotherapy options and future directions. Expert Opin Pharmacother 2017; 17:2431-2448. [PMID: 27817209 DOI: 10.1080/14656566.2016.1258061] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Sarcoidosis is a systemic disease of unknown etiology characterized by the development of non-caseating epitheloid granulomas. The lungs are the most commonly involved organ (>90% of cases), followed by the lymph nodes, the skin, and the eyes. Areas covered: This review summarizes current pharmacotherapy options and future directions for the development of new therapies. Glucocorticoids are the first-line therapy for sarcoidosis. For patients with the most severe forms of sarcoidosis (who will need glucocorticoids for long periods) and for those intolerant or refractory, immunosuppressive drugs are used as sparing agents. The management of extrathoracic sarcoidosis must be tailored to the specific organ or organs involved; however, there is limited data from controlled trials to guide the treatment of these patients. The emergence of biological therapies has increased the therapeutic armamentarium available to treat sarcoidosis, with monoclonal anti-TNF agents being the most promising, but their use is still limited by a lack of licensing and costs. Expert commentary: The treatment of sarcoidosis is still not totally standardized. New effective therapies are urgently needed to enable the reduction or replacement of long-term therapy with glucocorticoids in patients with sarcoidosis.
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Affiliation(s)
- Pilar Brito-Zerón
- a Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases , ICMiD, Hospital Clínic , Barcelona , Spain.,b Autoimmune Diseases Unit, Department of Medicine , Hospital CIMA- Sanitas , Barcelona , Spain
| | | | - Lucio Pallarés
- d Systemic Autoimmune Diseases Unit, Department of Internal Medicine , Hospital de Son Espases , Palma de Mallorca , Spain
| | - Soledad Retamozo
- a Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases , ICMiD, Hospital Clínic , Barcelona , Spain.,e Hospital Privado , Centro Médico de Córdoba , Córdoba , Argentina
| | - Robert P Baughman
- f Department of Medicine , University of Cincinnati Medical Center , Cincinnati , OH , USA
| | - Manuel Ramos-Casals
- a Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases , ICMiD, Hospital Clínic , Barcelona , Spain.,g Department of Medicine , University of Barcelona , Barcelona , Spain
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Zhou Y, Lower EE, Li H, Farhey Y, Baughman RP. Clinical characteristics of patients with bone sarcoidosis. Semin Arthritis Rheum 2017; 47:143-148. [PMID: 28274482 DOI: 10.1016/j.semarthrit.2017.02.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/26/2017] [Accepted: 02/04/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the clinical features, diagnosis, and treatment of bone sarcoidosis in the United States. METHODS Patients with bone sarcoidosis were identified and matched to sarcoidosis patients based on race, gender, and age. Detailed characteristics were obtained by medical record review. RESULTS A total of 64 patients with bone sarcoidosis were enrolled in this study. The female:male ratio was 1.46:1 and the white:black ratio was 3:1. Thirty-eight (59.4%) of 64 patients had bone symptoms. Compared to matched cases, bone sarcoidosis patients have more multi-organ involvement and higher incidence with liver, spleen, and extrathoracic lymph node involvement than controls (P < 0.05). Spine was the most commonly affected bone in 44 (68.8%) of patients, followed by pelvis (35.9%), and hands (15.6%). MRI and PET/CT scan was the common imaging technology, which performed in 36 patients and 32 patients, respectively, and with 97.2% and 93.8% positive bone uptake. Laboratory test indicated anemia was more common in bone sarcoidosis group than controls (P = 0.044). Infliximab was more commonly used in bone sarcoidosis patients than controls (P = 0.009). CONCLUSION Bone sarcoidosis was associated with multi-organs affection, and high frequency of liver, spleen, or extrathoracic lymph node involvement. Infliximab should be considered in those patients with aggressive and refractory bone sarcoidosis.
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Affiliation(s)
- Ying Zhou
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267; Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Elyse E Lower
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yolanda Farhey
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267
| | - Robert P Baughman
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267.
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Weinstock LB, Myers TL, Shetty A. Low-dose Naltrexone for the treatment of sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:184-187. [PMID: 32476841 DOI: 10.36141/svdld.v34i2.5303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/06/2016] [Indexed: 11/02/2022]
Abstract
Systemic therapy is administered to 50% of patients and the need for long-term use of therapy is quite variable (1,2). Prednisone is often administered for many months with risk for multiple side effects, immunomodulators as steroid sparing agents have a delayed onset of action and have risks for infection and malignancies, and infliximab increases the risk for infection (1). In light of these issues, alternative options for therapy are desirable. We made a comparison between sarcoidosis and Crohn's disease in that in each disease there is unregulated lymphocyte activity, a common unique pathological finding of non-caseating granulomas, and a similar approach to medical therapy (3,4). Low dose naltrexone (LDN) has been utilized for many conditions (5). Efficacy has been documented in Crohn's disease with randomized controlled studies showing mucosal healing and histologic improvement (6-7). LDN is compounded in 1/10th to 1/20th the dose used for the FDA-approved indications of narcotic and alcohol dependence (8). Neuropeptides (e.g., enkephalins and endorphins) are present in the gastrointestinal tract and endocrine cells and modulate immune responses (9). Up-regulation of met-enkephelin and opioid receptors can be induced by a rebound effect by short-acting LDN (10). Higher levels of endogenous opioids and receptors inhibit cell proliferation which suppress T and B lymphocyte responses (11,12) and decrease production of pro-inflammatory interleukins-6 and -12 (13). In light of the Crohn's disease LDN literature and similar experiences with other inflammatory conditions in our clinic (14,15), LDN was administered to a sarcoidosis patient with severe fatigue, sarcoid rash, and marked radiographic evidence of gastrointestinal involvement. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 184-187).
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Affiliation(s)
- Leonard B Weinstock
- Dept. Anesthesia and Internal Medicine, Washington University, School of Medicine, St. Louis, Missouri
| | | | - Anup Shetty
- Dept. of Radiology, Washington University, School of Medicine, St. Louis, Missouri
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Zhou Y, Lower EE, Li HP, Costea A, Attari M, Baughman RP. Cardiac Sarcoidosis. Chest 2017; 151:139-148. [DOI: 10.1016/j.chest.2016.08.1457] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/22/2016] [Accepted: 08/25/2016] [Indexed: 12/19/2022] Open
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Al-Kofahi K, Korsten P, Ascoli C, Virupannavar S, Mirsaeidi M, Chang I, Qaqish N, Saketkoo LA, Baughman RP, Sweiss NJ. Management of extrapulmonary sarcoidosis: challenges and solutions. Ther Clin Risk Manag 2016; 12:1623-1634. [PMID: 27853374 PMCID: PMC5106225 DOI: 10.2147/tcrm.s74476] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Sarcoidosis is a chronic multisystem disease of unknown etiology characterized by noncaseating granulomas that most often involves the lungs, but frequently has extrapulmonary manifestations, which might be difficult to treat in individual patients. Objective To review different disease manifestations, focusing on extrapulmonary organ systems, and to provide treatment options for refractory cases. Materials and methods We performed a literature search using Medline and Google Scholar for individual or combined keywords of “sarcoidosis, extrapulmonary, treatment, kidney, neurosarcoidosis, cardiovascular, gastrointestinal, transplantation, musculoskeletal, rheumatology, arthritis, and skin”. Peer-reviewed articles, including review articles, clinical trials, observational trials, and case reports that were published in English were included. References from retrieved articles were also manually searched for relevant articles. Results and conclusion Isolated involvement of a single organ or organ system is rare in sarcoidosis, and thus all patients must be thoroughly evaluated for additional disease manifestations. Cardiac sarcoidosis and neurosarcoidosis may be life-threatening. Clinicians need to assess patients comprehensively using clinical, laboratory, imaging, and histopathological data to recommend competently the best and least toxic treatment option for the individual patient.
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Affiliation(s)
- Khalid Al-Kofahi
- Department of Molecular Biosciences, University of Kansas, Lawrence, KS, USA
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Christian Ascoli
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
| | | | - Mehdi Mirsaeidi
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Ian Chang
- Department of Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Naim Qaqish
- Department of Gastroenterology, Hepatology and Nutrition, University of Buffalo, Buffalo, NY
| | - Lesley A Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Robert P Baughman
- Department of Medicine, University Medical Center of Cincinnati, Cincinnati, OH, USA
| | - Nadera J Sweiss
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL; Division of Rheumatology, University of Illinois at Chicago, Chicago, IL
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Sarcoïdose pulmonaire : aspects cliniques et modalités thérapeutiques. Rev Med Interne 2016; 37:594-607. [DOI: 10.1016/j.revmed.2016.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 11/22/2022]
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Huitema MP, Grutters JC, Rensing BJWM, Reesink HJ, Post MC. Pulmonary hypertension complicating pulmonary sarcoidosis. Neth Heart J 2016; 24:390-399. [PMID: 27194118 PMCID: PMC4887307 DOI: 10.1007/s12471-016-0847-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Pulmonary hypertension (PH) is a severe complication of sarcoidosis, with an unknown prevalence. The aetiology is multifactorial, and the exact mechanism of PH in the individual patient is often difficult to establish. The diagnostic work-up and treatment of PH in sarcoidosis is complex, and should therefore be determined by a multidisciplinary expert team in a specialised centre. It is still a major challenge to identify sarcoidosis patients at risk for developing PH. There is no validated algorithm when to refer a patient suspected for PH, and PH analysis itself is difficult. Until present, there is no established therapy for PH in sarcoidosis. Besides optimal treatment for sarcoidosis, case series evaluating new therapeutic options involving PH-targeted therapy are arising for a subgroup of patients. This review summarises the current knowledge regarding the aetiology, diagnosis and possible treatment options for PH in sarcoidosis.
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Affiliation(s)
- M P Huitema
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
| | - J C Grutters
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.,Division of Heart and Lung, UMC Utrecht, Utrecht, The Netherlands
| | - B J W M Rensing
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - H J Reesink
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
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Cinetto F, Agostini C. Advances in understanding the immunopathology of sarcoidosis and implications on therapy. Expert Rev Clin Immunol 2016; 12:973-88. [DOI: 10.1080/1744666x.2016.1181541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Saketkoo LA, Baughman RP. Biologic therapies in the treatment of sarcoidosis. Expert Rev Clin Immunol 2016; 12:817-25. [DOI: 10.1080/1744666x.2016.1175301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, University Medical Center Comprehensive Pulmonary Hypertension Center, Tulane University Lung Center, New Orleans, LA, USA
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Shen Y, Pang C, Wu Y, Li D, Wan C, Liao Z, Yang T, Chen L, Wen F. Diagnostic Performance of Bronchoalveolar Lavage Fluid CD4/CD8 Ratio for Sarcoidosis: A Meta-analysis. EBioMedicine 2016; 8:302-308. [PMID: 27428439 PMCID: PMC4919536 DOI: 10.1016/j.ebiom.2016.04.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/08/2016] [Accepted: 04/20/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The usefulness of bronchoalveolar lavage fluid (BALF) CD4/CD8 ratio for diagnosing sarcoidosis has been reported in many studies with variable results. Therefore, we performed a meta-analysis to estimate the overall diagnostic accuracy of BALF CD4/CD8 ratio based on the bulk of published evidence. METHODS Studies published prior to June 2015 and indexed in PubMed, OVID, Web of Science, Scopus and other databases were evaluated for inclusion. Data on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were pooled from included studies. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. Deeks's funnel plot was used to detect publication bias. RESULTS Sixteen publications with 1885 subjects met our inclusion criteria and were included in this meta-analysis. Summary estimates of the diagnostic performance of the BALF CD4/CD8 ratio were as follows: sensitivity, 0.70 (95%CI 0.64-0.75); specificity, 0.83 (95%CI 0.78-0.86); PLR, 4.04 (95%CI 3.13-5.20); NLR, 0.36 (95%CI 0.30-0.44); and DOR, 11.17 (95%CI 7.31-17.07). The area under the SROC curve was 0.84 (95%CI 0.81-0.87). There was no evidence of publication bias. CONCLUSION Measuring the BALF CD4/CD8 ratio may assist in the diagnosis of sarcoidosis when interpreted in parallel with other diagnostic factors.
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Affiliation(s)
- Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Caishuang Pang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Diandian Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Zenglin Liao
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Ting Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China.
| | - Fuqiang Wen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu 610041, China.
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Zhou Y, Lower EE, Li H, Baughman RP. Clinical management of pulmonary sarcoidosis. Expert Rev Respir Med 2016; 10:577-91. [DOI: 10.1586/17476348.2016.1164602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lee JS, Fischer A. Current and emerging treatment options for interstitial lung disease in patients with rheumatic disease. Expert Rev Clin Immunol 2016; 12:509-20. [PMID: 26752397 DOI: 10.1586/1744666x.2016.1139454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of connective tissue disease-associated interstitial lung disease (CTD-ILD) is complex and this arena offers many challenges to the practicing clinician. Unfortunately, treatment strategies and recommendations are often based on experience rather than evidence, and there are few effective therapeutic options. Pharmacologic intervention with immunosuppression is usually the mainstay of therapy and is reserved for those with clinically significant and/or progressive ILD. There is a desperate need for controlled trials across the spectrum of CTD-ILD and a number of potentially promising novel therapies warrant further study. It is important to address co-morbid conditions or aggravating factors (e.g., gastroesophageal reflux, aspiration, bone health, pulmonary hypertension, Pneumocystis jiroveci prophylaxis) and to institute non-pharmacologic management strategies (e.g., supplemental oxygen and cardiopulmonary rehabilitation) as part of a comprehensive treatment plan in CTD-ILD.
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Affiliation(s)
- Joyce S Lee
- a Department of Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Aryeh Fischer
- a Department of Medicine , University of Colorado School of Medicine , Aurora , CO , USA
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