Immunomodulators and Biologics for Granulomatous Diseases

George Hahn discusses the use of immunomodulators and biologics in treating granulomatous diseases, particularly focusing on skin conditions such as sarcoidosis and granuloma annulare. He highlights the importance of an evolving understanding of macrophage activity in these diseases, where macrophages play a central role in chronic inflammation. Sarcoidosis, with its genetic and environmental risk factors, often leads to self-resolving cases but can also present chronic symptoms. The speaker emphasizes the use of TNF-alpha inhibitors like adalimumab and infliximab as effective treatments, particularly in refractory cases, but notes the challenges in conducting clinical trials due to the tendency of the disease to spontaneously remit. He also discusses the potential of JAK inhibitors, particularly tofacitinib, showing promise in patients who have failed other treatments. In discussing granuloma annulare, he mentions the controversial associations with underlying conditions and the limited effectiveness of traditional therapies. The presentation implies that while current biologic therapies provide some benefits, there is still a significant need for better-targeted treatments for these granulomatous conditions. Hahn concludes with a call for more research and development in this area, encouraging healthcare providers to advocate for advancements in treatment options.