title: Efficacy of infliximab in a patient with refractory idiopathic retroperitoneal fibrosis.
abstract: Glucocorticoids are the mainstay of treatment of idiopathic retroperitoneal fibrosis (IRF). However, relapses are frequent upon tapering of the glucocorticoid dose. A variety of traditional immunosuppressants have been proposed as steroid-sparing agents, but some patients fail to adequately respond to combined glucocorticoid and immunosuppressive therapy. We report a patient with IRF refractory to combined glucocorticoid and methotrexate therapy treated with the anti-TNF-α monoclonal antibody infliximab. Infliximab was administered at 5 mg/kg/bodyweight at week 0, 2, 6 and 8-weekly thereafter for 3 consecutive years. Drug efficacy and safety were assessed clinically and by laboratory tests at treatment onset and subsequently before each infusion. In addition, 18FFluorodeoxyglucose (FDG) positron emission computerised tomography (PET/CT) and abdominal CT scans were used to monitor disease activity and response to treatment. Infliximab therapy resulted in a satisfactory clinical and laboratory response paralleled by an improvement in imaging findings. No serious adverse events were noted. Infliximab may be an effective and safe treatment for refractory IRF. A controlled study is required to confirm our findings.
authors.affiliation: Rheumatology Unit, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy. catanoso.mariagrazia@asmn.re.it
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Catanoso
authors.forename: Lucia
authors.initials: L
authors.lastname: Spaggiari
authors.forename: Luca
authors.initials: L
authors.lastname: Magnani
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pipitone
authors.forename: Annibale
authors.initials: A
authors.lastname: Versari
authors.forename: Luigi
authors.initials: L
authors.lastname: Boiardi
authors.forename: Giulia
authors.initials: G
authors.lastname: Pazzola
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Pattacini
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D019788:Fluorodeoxyglucose F18; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012185:Retroperitoneal Fibrosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000069285:Infliximab; D008727:Methotrexate