TY - JOUR
T1 - Etanercept for the treatment of stage II and III progressive pulmonary sarcoidosis
AU - Utz, James P.
AU - Limper, Andrew H.
AU - Kalra, Sanjay
AU - Specks, Ulrich
AU - Scott, John P.
AU - Vuk-Pavlovic, Zvezdana
AU - Schroeder, Darrell R.
N1 - Funding Information:
This research was supported by funds from the Mayo Foundation, Immunex Corporation, and the Robert N. Brewer Foundation.
PY - 2003/7/1
Y1 - 2003/7/1
N2 - Background: Tumor necrosis factor (TNF)-α is produced by macrophages and other cells, and is believed to participate in granulomatous inflammation. Targeted antagonism of TNF-α has been proposed as a novel treatment strategy for sarcoidosis. Etanercept is a dimeric fusion protein that binds specifically to TNF-α, rendering it biologically inactive. Objective: To assess whether etanercept has potential efficacy in the treatment of progressive pulmonary sarcoidosis. Design: Prospective, open-label, phase-2 treatment trial. Setting: Mayo Clinic, Rochester, MN. Patients: Stage II or III progressive pulmonary sarcoidosis. Intervention: Etanercept, 25 mg subcutaneously twice weekly. Measurements: Pulmonary function, chest radiographs, dyspnea, and TNF-α levels in serum and BAL fluid. Results: The study was terminated after the enrollment of 17 patients due to an early-stop clause of the pretrial study design related to excessive treatment failures. Neither absolute levels of TNF-α nor TNF-α activity in the serum, BAL fluid, or alveolar macrophages were able to predict which patients would respond to etanercept. Conclusions: In patients with progressive stage II or III pulmonary sarcoidosis, etanercept was frequently associated with early or late treatment failure. These data would not support the design of a large multicenter randomized trial comparing etanercept with conventional corticosteroid therapy.
AB - Background: Tumor necrosis factor (TNF)-α is produced by macrophages and other cells, and is believed to participate in granulomatous inflammation. Targeted antagonism of TNF-α has been proposed as a novel treatment strategy for sarcoidosis. Etanercept is a dimeric fusion protein that binds specifically to TNF-α, rendering it biologically inactive. Objective: To assess whether etanercept has potential efficacy in the treatment of progressive pulmonary sarcoidosis. Design: Prospective, open-label, phase-2 treatment trial. Setting: Mayo Clinic, Rochester, MN. Patients: Stage II or III progressive pulmonary sarcoidosis. Intervention: Etanercept, 25 mg subcutaneously twice weekly. Measurements: Pulmonary function, chest radiographs, dyspnea, and TNF-α levels in serum and BAL fluid. Results: The study was terminated after the enrollment of 17 patients due to an early-stop clause of the pretrial study design related to excessive treatment failures. Neither absolute levels of TNF-α nor TNF-α activity in the serum, BAL fluid, or alveolar macrophages were able to predict which patients would respond to etanercept. Conclusions: In patients with progressive stage II or III pulmonary sarcoidosis, etanercept was frequently associated with early or late treatment failure. These data would not support the design of a large multicenter randomized trial comparing etanercept with conventional corticosteroid therapy.
KW - BAL
KW - Etanercept
KW - Sarcoidosis
KW - Tumor necrosis factor-α
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U2 - 10.1378/chest.124.1.177
DO - 10.1378/chest.124.1.177
M3 - Article
C2 - 12853521
AN - SCOPUS:0038498467
SN - 0012-3692
VL - 124
SP - 177
EP - 185
JO - Chest
JF - Chest
IS - 1
ER -