Assessment of treatment response in cardiac sarcoidosis based on myocardial 18 F-FDG uptake
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fimmu-14-1286684.pdf
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Author(s)
Frischknecht, Lukas
Schaab, Jan
Schmauch, Eloi
Yalamanoglu, Ayla
Arnold, Dennis
Schwaiger, Judith
Gruner, Christiane
Buechel, Ronny
Franzen, Daniel
Kolios, Antonios
Date Issued
November 24, 2023
Journal
Frontiers in Immunology
Publisher
Frontiers Media SA
Citation
Frischknecht L, Schaab J, Schmauch E, Yalamanoglu A, Arnold DD, Schwaiger J, Gruner C, Buechel RR, Franzen DP, Kolios AGA and Nilsson J (2023) Assessment of treatment response in cardiac sarcoidosis based on myocardial 18F-FDG uptake. Front. Immunol. 14:1286684.
Version
Final published version
Abstract
Objective: Immunosuppressive therapy for cardiac sarcoidosis (CS) still largely consists of corticosteroid monotherapy. However, high relapse rates after tapering and insufficient efficacy are significant problems. The objective of this study was to investigate the efficacy and safety of non-biological and biological disease-modifying anti-rheumatic drugs (nb/bDMARDs) considering control of myocardial inflammation assessed by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) of the heart. Methods: We conducted a retrospective analysis of treatment response to nb/bDMARDs of all CS patients seen in the sarcoidosis center of the University Hospital Zurich between January 2016 and December 2020. Results: We identified 50 patients with CS. Forty-five patients with at least one follow-up PET/CT scan were followed up for a mean of 20.5 ± 12.8 months. Most of the patients were treated with prednisone and concomitant nb/bDMARDs. At the first follow-up PET/CT scan after approximately 6.7 ± 3 months, only adalimumab showed a significant reduction in cardiac metabolic activity. Furthermore, comparing all serial follow-up PET/CT scans (143), tumor necrosis factor inhibitor (TNFi)-based therapies showed statistically significant better suppression of myocardial 18F-FDG uptake compared to other treatment regimens. On the last follow-up, most adalimumab-treated patients were inactive (n = 15, 48%) or remitting (n = 11, 35%), and only five patients (16%) were progressive. TNFi was safe even in patients with severely reduced left ventricular ejection fraction (LVEF), and a significant improvement in LVEF under TNFi treatment was observed. Conclusion: TNFi shows better control of myocardial inflammation compared to nbDMARDs and corticosteroid monotherapies in patients with CS. TNFi was efficient and safe even in patients with severely reduced LVEF.
Subjects
cardiac sarcoidosis
myocardial 18F-FDG PET
Anti-TNF
adalimumab
azathioprin
SUVmax
cardiac metabolic activity
MIT Department
Broad Institute of MIT and Harvard
Massachusetts Institute of Technology. Computer Science and Artificial Intelligence Laboratory
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Creative Commons Attribution
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DOI of Published Version
https://doi.org/10.3389/fimmu.2023.1286684
