{"id":"2c89ac7abcef","type":"article","url":"https://hartvaat.nl/2026/03/31/tofacitinib-bij-cardiale-sarcoidose-veelbelovend-als-corticosteroidsparende-beha/","title":"Tofacitinib bij cardiale sarcoïdose: veelbelovend als corticosteroïdsparende behandeling","title_en":"Tofacitinib in the treatment of cardiac sarcoidosis: towards steroid-sparing disease management","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiale-sarcoidose","trombocytenaggregatieremmers"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003659?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003659?rss=1","authors":["Frischknecht","L.","Stu&#x0308;ssi-Helbling","M.","Tian","Y.","Mallone","A.","Farokhnia","A.","Buechel","R.","Kolios","A. G.","Nilsson","J."],"significance":5,"published":"2026-03-31","source_date":"2026-03-31","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/coronairlijden/ranolazine-bij-angina/"],"congress":"","summary_en":"Cardiac sarcoidosis (CS) is difficult to treat, especially in patients who fail immunosuppressants and second-line TNF inhibitors; these refractory cases often lead to serious complications. This study treated eight patients with (probable) refractory CS with the JAK inhibitor tofacitinib (University Hospital Zurich, 2020-2024), tracking inflammation with 18F-FDG PET/CT, ejection fraction, corticosteroid use and blood neopterin. Seven of eight patients (87.5%) achieved inactive or remitting disease, with decreased myocardial uptake; ejection fraction stabilised or improved and the mean daily prednisone dose fell from 5.94 to 2.5 mg. Tofacitinib thus shows promising results in treatment-refractory cardiac sarcoidosis, though larger prospective studies are needed to confirm efficacy and safety.","created":"2026-07-03T10:32:20Z","updated":"2026-07-03T13:31:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cardiale sarcoïdose (CS) is lastig te behandelen, zeker bij patiënten die niet reageren op immunosuppressiva en tweedelijns-TNF-remmers; deze refractaire gevallen leiden vaak tot ernstige complicaties. Deze studie behandelde acht patiënten met (waarschijnlijke) refractaire CS met de JAK-remmer tofacitinib (Universitair Ziekenhuis Zürich, 2020-2024) en volgde de ontsteking met 18F-FDG-PET/CT, de ejectiefractie, het corticosteroïdgebruik en het neopterine in het bloed. Zeven van de acht patiënten (87,5%) bereikten een inactieve of remitterende ziekte, met afname van de myocardiale opname; de ejectiefractie stabiliseerde of verbeterde en de gemiddelde dagelijkse prednisondosis daalde van 5,94 naar 2,5 mg. Tofacitinib toont dus veelbelovende resultaten bij therapieresistente cardiale sarcoïdose, al zijn grotere prospectieve studies nodig om de werkzaamheid en veiligheid te bevestigen.","abstract_original":"<sec><st>Background</st>\n<p>Cardiac sarcoidosis (CS) creates complex treatment challenges, especially for patients who fail to respond to immunosuppressive drugs, including second-line tumour necrosis factor inhibitors. These refractory cases frequently lead to serious complications and worse prognosis, prompting exploration of new therapies like Janus kinase (JAK) inhibitors.</p>\n</sec>\n<sec><st>Methods</st>\n<p>This study included eight patients with refractory CS or probable CS treated with the JAK inhibitor tofacitinib at the University Hospital Zurich from 2020 to 2024. Treatment outcomes were assessed through changes in myocardial as well as nodal and pulmonary inflammation via 18-F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) scans, left ventricular ejection fraction (LVEF), corticosteroid use and blood neopterin levels.</p>\n</sec>\n<sec><st>Results</st>\n<p>Seven out of eight patients (87.5%) who received tofacitinib achieved inactive or remitting disease as assessed by repeat myocardial 18F-FDG PET/CT, with a decrease in both standardised uptake value (SUVmax and cardiac metabolic activity. In the treated patients, LVEF stabilised or improved, and the corticosteroid dose was substantially reduced, with the average daily prednisone dose dropping from 5.94 mg to 2.5 mg. Blood neopterin levels, indicative of macrophage activation, as well as extra cardiac SUVmax (nodal and pulmonal) as assessed by repeat 18F-FDG PET/CT also decreased in a majority of the treated patients.</p>\n</sec>\n<sec><st>Conclusion</st>\n<p>Tofacitinib shows promising results in managing treatment-refractory CS, with seven out of eight patients achieving significant reduction in myocardial inflammation and corticosteroid dependency. However, further studies with larger prospective cohorts are essential to solidify these findings and assess the drug&rsquo;s efficacy and safety profile in this complex patient group.</p>\n</sec>"}