Post by Sarcoidawareness on Oct 15, 2008 9:38:39 GMT -5
A number of new treatments as well as older medications that have not yet been tested much in people with sarcoidosis might hold promise as sarcoidosis treatments. Researchers are particularly interested in treatments that target specific parts of the immune response. You should tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding and taking any of these drugs.
Infliximab (brand name: Remicade®) was developed to treat Crohn’s disease, one of the inflammatory bowel diseases. It has since been approved for several other inflammatory diseases, including rheumatoid arthritis. It is delivered by infusion in a medical setting. Researchers recently found infliximab to be effective in reducing the sarcoidosis symptoms of people who did not respond to other treatments, but these results came from small, short-term studies. Infliximab can cause a variety of side effects, including chest pain, fever, hives, trouble breathing, nausea, headache, abdominal pain, and sore throat. It also increases the risk of infection and slightly increases the risk of certain types of cancer.
Etanercept (brand name: Enbrel®) is in the same class of new inflammatory treatments as infliximab. However, it is delivered by injection, not infusion, and you can give it to yourself at home. It was developed to treat rheumatoid arthritis and has since been approved for a variety of other inflammatory diseases. Researchers have tested it, too, in small studies of people with various sarcoidosis symptoms, but results to date have been mixed and less promising than for infliximab. Etanercept can cause many of the same side effects as listed above for infliximab. It, too, increases the risk of infection and slightly increases the risk of certain types of cancer.
Adalimumab (brand name: Humira®) is in the same class of treatments as etanercept and infliximab. It is delivered by injection, and you can give it to yourself at home. Adalimumab has been approved to treat rheumatoid arthritis and several other types of arthritis. Its value as a treatment for sarcoidosis is unknown because it has not been tested in clinical trials with people with sarcoidosis, but some doctors prescribe it for their sarcoidosis patients. It can cause many of the same side effects as described above for infliximab and etanercept. It also increases the risk of infection and might slightly increase the risk of certain types of cancer.
Thalidomide (Thalomid) is used to treat certain skin problems, and researchers have been interested to see if thalidomide improves sarcoidosis. In very small studies it was effective in some people who had skin and lung involvement. Side effects associated with thalidomide include drowsiness, dizziness, slowed heartbeats, rashes, and numbness or tingling in the hands or feet. More studies are needed to determine whether thalidomide might be useful for treating sarcoidosis. The drug will cause severe birth defects, so women who are pregnant, who are thinking of becoming pregnant, or who are at risk for becoming pregnant should not take it. Women who are breastfeeding also should not take thalidomide.
Pentoxifylline (brand name: Trental®) is used to reduce leg pain caused by poor blood circulation. Because of its anti-inflammatory effects, researchers are interested to see if pentoxifylline is useful as a combination treatment that allows for a lower dosage of corticosteroids. , Pentoxifylline’s side effects include dizziness, headaches, nausea, and stomach discomfort. More large-scale studies are needed to determine whether pentoxifylline has a role in sarcoidosis treatment.
Tetracyclines, such as minocycline and doxycycline, are antibiotic medicines used to control a variety of infections and acne. Very small studies have shown that they might also improve the skin symptoms of sarcoidosis. No clinical studies have shown that these drugs improve sarcoidosis that affects the lungs or any other organs. The side effects of tetracyclines include increased sensitivity to the sun, stomach cramps, and diarrhea. More research on the efficacy of tetracyclines for sarcoidosis is needed.
ORGAN SPECIFIC TREATMENTS
Depending on how sarcoidosis affects you, you might need to treat specific symptoms of the disease on their own, with medications besides corticosteroids or the corticosteroid alternatives mentioned above. Below are a few of the most common treatments for various types of sarcoidosis.
In patients with sarcoidosis affecting their heart, heart drugs may be given to improve the heart’s pumping ability or to correct a disturbed heart rhythm. If a rhythm disturbance is severe, it may be restored to normal by use of a cardiac pace-maker or defibrillator. Lung or heart transplantation may be indicated in the case of severe pulmonary or heart failure.
Monitoring Treatment
Patients with sarcoidosis need to have their condition checked during and after treatment. Those who do not receive treatment also need regular checkups, since symptoms can develop later. Patients should work with their sarcoidosis specialist and regular physician to develop a schedule of periodic examinations and laboratory tests.
The follow-up examination usually includes a review of symptoms, a physical examination, a chest x-ray, breathing tests and laboratory blood tests. How often these examinations and tests are done depends on the severity of the symptoms and the organs affected at diagnosis, the therapy used and any complications that may develop during treatment.
