Assessment of treatment response in cardiac sarcoidosis based on myocardial 18F-FDG uptake

Lukas Frischknecht; Jan Schaab; Eloi Schmauch; Ayla Yalamanoglu; Dennis D Arnold; Judith Schwaiger; Christiane Gruner; Ronny R Buechel; Daniel P Franzen; Antonios G A Kolios; Jakob Nilsson

doi:10.3389/fimmu.2023.1286684

Assessment of treatment response in cardiac sarcoidosis based on myocardial ¹⁸F-FDG uptake

Front Immunol. 2023 Nov 24:14:1286684. doi: 10.3389/fimmu.2023.1286684. eCollection 2023.

Authors

Lukas Frischknecht^#¹, Jan Schaab^#², Eloi Schmauch^{3

4

5}, Ayla Yalamanoglu¹, Dennis D Arnold¹, Judith Schwaiger⁶, Christiane Gruner⁶, Ronny R Buechel², Daniel P Franzen⁷, Antonios G A Kolios^#^{1

8}, Jakob Nilsson^#¹

Affiliations

¹ Department of Immunology, University Hospital Zurich (USZ), Zurich, Switzerland.
² Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
³ Broad Institute of MIT and Harvard, Cambridge, MA, United States.
⁴ Artturi Ilmari (A.I) Virtanen Institute, University of Eastern Finland, Kuopio, Finland.
⁵ Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States.
⁶ Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
⁷ Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
⁸ Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.

^# Contributed equally.

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.

Keywords: Anti-TNF; SUVmax; adalimumab; azathioprin; cardiac metabolic activity; cardiac sarcoidosis; myocardial 18F-FDG PET.

MeSH terms

Adalimumab / therapeutic use
Adrenal Cortex Hormones / therapeutic use
Fluorodeoxyglucose F18
Humans
Inflammation / drug therapy
Myocarditis* / drug therapy
Positron Emission Tomography Computed Tomography / methods
Radiopharmaceuticals
Retrospective Studies
Sarcoidosis* / complications
Sarcoidosis* / diagnostic imaging
Sarcoidosis* / drug therapy
Stroke Volume
Ventricular Function, Left

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals
Adalimumab
Adrenal Cortex Hormones

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.