title: Long term follow-up of infliximab efficacy in pulmonary and extra-pulmonary sarcoidosis refractory to conventional therapy.
abstract: BACKGROUND
  Infliximab, a humanized, chimeric, monoclonal antibody against tumor necrosis alpha (TNF-α), has been shown to reduce the pulmonary and extra-pulmonary manifestations of sarcoidosis, however, there is little information regarding sustained efficacy with long-term use of infliximab. We retrospectively investigate whether a reduction in disease response is maintained, over a prolonged course of therapy (up to 85 months) with infliximab, and report on adverse events associated with its use.
  
  
  METHODS
  Subjects with multi-organ sarcoidosis were prescribed infliximab, between January 2000 to June 2010 due to failure of conventional therapy and were identified from the Drexel University College of Medicine sarcoidosis clinic. Retrospective patient reported symptom and objective clinical data analyses of pulmonary and extra-pulmonary findings were evaluated pre-infliximab and post or concurrent infliximab therapy. Any adverse events or reasons for discontinuation during infliximab therapy were reported.
  
  
  RESULTS
  Twenty-six patients with biopsy proven sarcoidosis received anti-TNF therapy and met the criteria for study inclusion. Clinical evidence of sustained resolution or improvement was demonstrated in 58.5% of all organs assessed (p =<0.001). No clinical change in disease activity was seen in 35.8% of all organs evaluated. Despite infliximab treatment, 5.7% had progressive disease activity. Adverse events were seen in 57.7% of patients treated with infliximab over a 46.2 month average duration of therapy. Three (12%) patients had an adverse event that required permanent discontinuation.
  
  
  CONCLUSIONS
  Infliximab is efficacious in the treatment of extra-pulmonary sarcoidosis and the efficacy is maintained with prolonged treatment. In patients with pulmonary sarcoid, sustained improvement in pulmonary imaging was seen after initiation of infliximab, however, post-treatment pulmonary function testing was not conclusive. Long-term infliximab therapy was well tolerated for our study group.
authors: Christiana Care Rheumatology Department,Wilmington, DE. USA. ERussell@ChristianaCare.org
authors: Eric
authors: E
authors: Russell
authors: Francis
authors: F
authors: Luk
authors: Sonia
authors: S
authors: Manocha
authors: Tung
authors: T
authors: Ho
authors: Carolyn
authors: C
authors: O'Connor
authors: Humaira
authors: H
authors: Hussain
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012507:Sarcoidosis / Q000188:drug therapy*; D017565:Sarcoidosis, Pulmonary / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000069285:Infliximab
keywords: AE; Anti-TNF; CNS; CT; DLCO; FEV1; FVC; HCQ; HPV; IFX; Infliximab; LN; MRI; MTX; PFT; PPD; Remicade; Sarcoid; Sarcoidosis; TLC; TNF; Tumor necrosis factor inhibitor; adverse events; carbon monoxide diffusing capacity; central nervous system; computerized tomography; forced expiratory volume in 1s; forced vital capacity; human papilloma virus; hydroxychloroquine; infliximab; lymph node; magnetic resonance imaging; methotrexate; pulmonary function test; purified protein derivative; total lung capacity; tumor necrosis factor