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Randomized Controlled Trial
. 2022 Mar 9;23(1):54.
doi: 10.1186/s12931-022-01971-5.

Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis

Abdullah Sakkat  1 , Gerard Cox  2   3 , Nader Khalidi  2   4 , Maggie Larche  2   4 , Karen Beattie  2   4 , Elisabetta A Renzoni  5 , Nilesh Morar  6 , Vasilis Kouranos  5 , Martin Kolb  2   3 , Nathan Hambly  2   3
Affiliations
Randomized Controlled Trial

Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis

Abdullah Sakkat et al. Respir Res. .

Abstract

Background: Infliximab is a monoclonal antibody that binds and neutralizes circulating tumor necrosis factor-alpha, a key inflammatory cytokine in the pathophysiology of sarcoidosis. Despite the paucity of randomized clinical trials, infliximab is often considered a therapeutic option for refractory disease. Our study aimed to investigate the effectiveness of infliximab in patients with refractory sarcoidosis.

Methods: Sarcoidosis patients from three tertiary centres were retrospectively identified by pharmacy records based on treatment with infliximab. Treatment with Infliximab was initiated in patients who failed first and second line immunomodulators as determined by a multidisciplinary team of Respirologists, Dermatologists, ENT specialists, Rheumatologists, and Neurologists. Participants were characterized by the primary organ for which infliximab was initiated and the total number of organs involved. Clinical outcomes were categorized as treatment success versus failure. We defined treatment success as (A) improvement of cutaneous, upper airway, lymph node, gastrointestinal, eye, or joint manifestations; or (B) improvement or no change in central nervous system (CNS) or pulmonary manifestations.

Results: 33 patients with refractory sarcoidosis were identified. The proportion of treatment success was 100% (95% CI 54.1-100) in CNS, 91.7% (95% CI 61.5-99.8) in cutaneous, 78.6% (95% CI 49.2-95.3) in pulmonary and 71.5% (95% CI 29.0-96.3) in upper airway disease. The use of infliximab was associated with a reduction prednisone dose by 50%.

Conclusion: Infliximab is possibly an effective therapy for refractory sarcoidosis, with the greatest value in neurologic and cutaneous manifestations. Across all disease presentations, infliximab facilitated a clinically relevant reduction in corticosteroid dose. Relapse is common after discontinuation of infliximab.

Keywords: Anti-TNF-α; Infliximab; Sarcoidosis.

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Conflict of interest statement

NH reports honoraria and grants from Boehringer-Ingelheim, Roche, Bayer, and Janssen, and he also sets on their advisory board. His involvement in such is not related to the manuscript. EA R reports education research grants and lecture fees from Boehringer Ingelheim, Roche and Chiesi outside the field of this review. ML reports honoraria from Abbvie, Amgen and UCB. NK reports grants from BMS (drug only), Sanofi and Abbvie for clinical trials and sets on Roche’s advisory board. MK reports funding for clinical registry from Boehringer Ingelheim and grants from Boehringer Ingelheim, Pieris and Roche. Consulting fees from Boehringer Ingelheim, Roche, Horizon, Cipla, Abbvie, Bellerophon, Algernon and CSL Behring. Lectures\speaker fees from Novartis, Boehringer Ingelheim and Roche. Expert testimony fee from Roche. He sets on data safety monitoring\advisory board of Covance and United Therapeutics. He also reports receiving chief editor allowance from the European Journal of Respirology. The remaining authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
A Individual patient (n = 11) absolute FCV at baseline and at 12 months post treatment with infliximab. B Individual patient (n = 5) absolute FCV at baseline, 12 and 36-months post treatment with infliximab. C Individual patient (n = 11) absolute FEV1 at baseline and at 12 months post treatment with infliximab. D Individual patient (n = 5) absolute FEV1 at baseline, 12 and 36-months post treatment with infliximab. IFX infliximab; FVC forced vital capacity; M month; L liters
Fig. 2
Fig. 2
Pre-treatment images of a patient with cutaneous sarcoidosis presenting with annular lesions, papules and plaques resulting in scarring, atrophy, hyperpigmentation and hypopigmentation (1A–1C). Post treatment images shows healed cutaneous sarcoidosis lesions with post-inflammatory hypopigmentation and atrophy (2A–2C)
Fig. 3
Fig. 3
Kaplan–Meier analysis of time (months) to clinical relapse after discontinuation of infliximab. Panel A demonstrates the time to clinical relapse of index organ in individual patients who initially responded to infliximab. Panel B describes the time to clinical worsening in index organs for which infliximab was prescribed
See this image and copyright information in PMC

References

    1. Hunninghake GW, Costabel U, Ando M, Baughman R, Cordier JF, du Bois R, Eklund A, Kitaichi M, Lynch J, Rizzato G, Rose C, Selroos O, Semenzato G, Sharma OP. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999;160(2):736–55. - PubMed
    1. Valeyre D, Prasse A, Nunes H, Uzunhan Y, Brillet PY, Müller-Quernheim J. Sarcoidosis. Lancet. 2014;383(9923):1155–1167. doi: 10.1016/S0140-6736(13)60680-7. - DOI - PubMed
    1. Llanos O, Hamzeh N. Sarcoidosis. Med Clin North Am. 2019;103(3):527–534. doi: 10.1016/j.mcna.2018.12.011. - DOI - PubMed
    1. Baughman RP, Nunes H, Sweiss NJ, Lower EE. Established and experimental medical therapy of pulmonary sarcoidosis. Eur Respir J. 2013;41(6):1424–1438. doi: 10.1183/09031936.00060612. - DOI - PubMed
    1. Baughman RP, Lower EE, du Bois RM. Sarcoidosis. Lancet. 2003;361(9363):1111–1118. doi: 10.1016/S0140-6736(03)12888-7. - DOI - PubMed

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