PURPOSE: Sarcoidosis is a multisystem inflammatory granulomatous disease. Multiple cytokine and chemokine pathways regulate granuloma formation, TNF α is considered to play a key role. Infliximab is a chimeric monoclonal antibody against TNF α. In this study we report our experience with infliximab in refractory sarcoidosis.
METHODS: Retrospective observational study between June 2003 and April 2006, at pulmonary out-patient practice with refractory sarcoidosis patients on infliximab. Data was collected regarding age at time of infliximab, time since diagnosis before starting infliximab, organs involved, medications prior to starting infliximab and medication changes after infliximab at 6 months, changes in symptoms and side effects.
RESULTS: Twenty patients were studied. The mean age was 47 with 3 males. The mean age on starting infliximab was 45.5 years, mean time since diagnosis before starting infliximab was 10.9 years. 17 patients had lung involvement, 13 skin, 11 joints, 9 lymph node, 8 CNS, 7 eyes, 5 liver, 4 bone, 3 sinuses, 2 kidney, 2 muscle, 1 laryngeal, 1 lacrimal, 1 parotid, 1 bone marrow, 1 erythema nodosum, 1 heart and 1 lupus pernio. Prior to starting infliximab, 6 patients were on methotrexate and plaquenil, 5 patients were on methotrexate, plaquenil and prednisone, 4 patients were on methotrexate alone, 3 were on prednisone alone and 2 patients were on methotrexate and prednisone. Infliximab resulted in significant improvement in symptoms and allowed steroids to be discontinued in 4 patients while the doses of steroid and other immunomodulators were reduced in the majority of our patients. Four patients had side effects with infliximab, one had frequent upper respiratory tract infections, one had leg pain, one had hemiplegia which resolved with stress dose steroids, one had fatigue and night sweats.
CONCLUSION: Infliximab is an effective and safe therapy for multisystem sarcoid refractory to immunomodulating therapy.
CLINICAL IMPLICATIONS: Infliximab should be considered for patients with joint, CNS, and bone involvement, despite the fact that the Centocor study (C0168T48) for sarcoidosis showed no significant improvement in FVC.
DISCLOSURE: Ghulam Khaleeq, None.