Effect of the TNF-α inhibitor adalimumab in patients with recalcitrant sarcoidosis: a prospective observational study using FDG-PET

Background: Tumour necrosis factor‐alpha (TNF‐α) plays a crucial role in sarcoidosis. In severe disease, treatment with TNF‐α inhibitors may be effective. Objectives: Changes in sarcoid disease activity were assessed by fluorine‐18‐fluorodeoxyglucose positron emission tomography (FDG‐PET) in patients with recalcitrant sarcoidosis treated with adalimumab. Methods: Prospective 24‐week observational study. Patients continued medication with steroids and antimetabolites and received adalimumab 40 mg subcutaneously every other week. Ten patients with biopsy‐proven sarcoidosis (two men) were included with a median age of 47 years (range 35–73). An FDG‐PET showing uptake indicating sarcoid activity was required at inclusion and repeated at the end of the study. FDG‐PET uptake was assessed by calculated standardised uptake value (SUV). Blood samples and lung function tests were performed regularly. Quality of life was assessed by the short‐form health survey (SF‐36) questionnaire. Results: Following treatment with adalimumab, FDG‐PET uptake decreased in nine patients (P = 0.011) and increased in one patient. Maximum SUV fell from median 14.1 to 7.0 (P