PhD thesis: ‘Optimization of pharmacotherapeutic options in sarcoidosis’.
Anne (J.P.) Cremers, MD
Clinical presentation and course of sarcoidosis are both highly variable, depending on several disease and patient characteristics. Most sarcoidosis patients show spontaneous resolution, but in patients with a severe disease course and poor prognosis a timely implementation of an appropriate customized individual pharmacological treatment regimen is important to avoid or slow down the development of complications and to alleviate the disease burden. Despite the availability of several immunosuppressive therapeutic options in sarcoidosis, standardized management strategies are lacking. The published data on the different pharmacological therapeutics are limited and the treatment therefore remains predominantly empiric. The aim of the studies presented in this thesis was to contribute in the optimization and improvement of pharmacotherapeutic options in sarcoidosis. Several aspects in terms of amelioration of treatment were investigated, with emphasis on the meaning of body composition profiling, the desirable handling of liver test abnormalities, and the development of practical recommendations for the optimal use of methotrexate (MTX) and tumor necrosis factor?alpha (TNF?α) inhibitors in sarcoidosis. Furthermore, possible factors identifying responders to TNF?α inhibitors were explored. Four studies included data from sarcoidosis patients who were referred to a tertiary referral centre in the Netherlands. Two studies evaluated the experience with therapeutic agents amongst sarcoidosis experts worldwide by means of online web?based questionnaires, and combined these data with evidence from the literature. A general overview of the findings from this thesis is subsequently presented.
More information: see http://www.ildcare.nl/index.php/optimization-pharmacotherapeutic-options-sarcoidosis/