Sarcoidosis is a chronic granulomatous disease in which primary cytokine tumor necrosis factor (TNF)-alpha plays a major role in perpetuating the inflamation. Corticosteroids, antimalerials, immunosupperssive agents, thalidomide, and pentoxifylline have been used to control the disease. We used infliximab (Remicade) in ten patients with sarcoidosis who had earlier developed severe side-effects or responded poorly to traditional treatment.
Ten patients with biopsy proven multisystem sarcoidosis selected for infliximab therapy include 7 women and 3 men. The group comprised of 6 Caucasians, 3 African-Americans, and 1 Hispanic. The duration of sarcoidosis varied from 3 to 37 years. Eight patients had chronic skin lesions, 3 patients had pulmonary involvement and 2 patients had neurosarcoidosis. Hypercalcemia and peripheral lymphadenopathy occurred in 1 patient.
All patients treated with infliximab showed objective evidence of improvement. One patient developed plasma cell dyscrasia after showing a marked improvement of her sarcoidosis after six infusions.
Infliximab is an effective treatment for patients with refractory sarcoidosis of skin, central nervous system, bones, lungs, and herpercalcemia. The long-term effects of the drug are not known. The drug may reactivate latent tuberculosis. The relationship with plasma cell dyscrasias and lymphoproliferative diseases remains unexplained.
Infliximab may be used as an effective therapeutic agent for patients with sarcoidosis who are refractory to traditional treatment options.
S. Ghodsian, None.