Infliximab efficacy and safety against refractory systemic necrotising vasculitides: long-term follow-up of 15 patients.
BACKGROUND
Results of uncontrolled studies have suggested that infliximab is efficacious against systemic necrotising vasculitides (SNV) refractory to conventional treatment. However, its safety and ability to induce and maintain remission over the long term remain unknown.


OBJECTIVE
To report the use of infliximab to treat refractory SNV, focusing on patients' longer-term outcomes.


METHODS
The medical charts of patients given adjunctive infliximab for refractory SNV >/=2 years before this evaluation were reviewed retrospectively.


RESULTS
The 15 patients (median age 46 (range 20-69) years, median follow-up 35 (24-41) months) included 10 with Wegener's granulomatosis, 1 microscopic polyangiitis, 3 rheumatoid arthritis-associated and 1 cryoglobulinaemia-related vasculitides. Infliximab was taken for a median time of 8 (2-31) months; 2 patients are still being treated. By day 45, 11 patients had entered remission (Birmingham Vasculitis Activity Score (BVAS) = 0) and 4 others had responded (BVAS decrease >/=50%). Five patients achieved sustained remissions (>/=6 months, corticosteroids </=7.5 mg/day). Thirteen stopped infliximab because of loss of efficacy (n = 4), remission (n = 6) or non-compliance, chest tightness or side effect (1 each). Ten patients relapsed (median interval 13 months), 3 while still receiving infliximab; 2 were successfully re-treated with infliximab.


CONCLUSIONS
These observations highlight infliximab as a potentially useful and safe salvage treatment for patients with refractory SNV.
Josselin
L
L
Department of Internal Medicine, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France.
Mahr
A
A
Cohen
P
P
Pagnoux
C
C
Guaydier-Souquières
G
G
Hayem
G
G
Job-Deslandre
C
C
Liferman
F
F
Pourrat
J
J
Guillevin
L
L
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014657:Vasculitis / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab; D011241:Prednisone