title: Refractory multisystem sarcoidosis responding to infliximab therapy.
abstract: Chronic progressive multisystem granulomatous disease is seen in 10-30% of patients with sarcoidosis and can result in end organ damage. Corticosteroids are the mainstay of treatment with the addition of cytotoxic agents in severe cases. Some patients are refractory to such treatment and, therefore, management is a challenge. There is currently limited evidence for biological agents such as infliximab, a monoclonal anti-tumor necrosis factor-α antibody in the treatment of multisystem sarcoidosis. We report outcomes of three patients with extensive multisystem sarcoidosis refractory to conventional treatment and treated at our center. Clinical assessment and radiographic imaging were used to assess the response to infliximab treatment. Infliximab therapy induced clinical remission in all three patients, and this clinical response correlated with radiographic evidence of the resolution of granulomatous disease. Serum ACE level was reduced in all cases, and daily steroid dosage was reduced. We propose that infliximab can be an effective treatment in patients with multisystem complex sarcoidosis refractory to conventional drug therapy and can result in sustained clinical remission. Our experience supports the urgent need for randomized controlled clinical trials of anti-TNF therapy in refractory systemic sarcoidosis.
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Dudley Road, Birmingham, UK.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Croft
authors.forename: Deva
authors.initials: D
authors.lastname: Situnayake
authors.forename: Omer
authors.initials: O
authors.lastname: Khair
authors.forename: Gavin
authors.initials: G
authors.lastname: Giovanni
authors.forename: David
authors.initials: D
authors.lastname: Carruthers
authors.forename: Arul
authors.initials: A
authors.lastname: Sivaguru
authors.forename: Caroline
authors.initials: C
authors.lastname: Gordon
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology; D006801:Humans; D007249:Inflammation; D000069285:Infliximab; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011239:Prednisolone / Q000627:therapeutic use; D012074:Remission Induction; D012507:Sarcoidosis / Q000188:drug therapy* / Q000276:immunology*; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D019788:Fluorodeoxyglucose F18; D011239:Prednisolone; D000069285:Infliximab