Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis.
Inconclusive evidence for the efficacy of infliximab in sarcoidosis hinders the global use of this potentially beneficial drug. To study infliximab efficacy in a clinical setting, we performed a prospective open-label trial in patients refractory to conventional treatment. Patients (n=56) received eight infusions of 5 mg·kg(-1) infliximab. Pulmonary function, disease activity measured by (18)F-fluorodeoxyglucose (FDG) by positron emission tomography (PET) and quality of life were part of the clinical work-up. Infliximab levels were measured before every infusion. After 26 weeks of infliximab treatment, mean improvement in forced vital capacity (FVC) was 6.6% predicted (p=0.0007), whereas in the 6 months before start of treatment, lung function decreased. Maximum standardised uptake value (SUVmax) of pulmonary parenchyma on (18)F-FDG PET decreased by 3.93 (p<0.0001). High SUVmax of pulmonary parenchyma at baseline predicted FVC improvement (R=0.62, p=0.0004). An overall beneficial response was seen in 79% of patients and a partial response was seen in 17% of patients. No correlation between infliximab trough level (mean 18.0 µg·mL(-1)) and initial response was found. In conclusion, infliximab causes significant improvement in FVC in refractory (18)F-FDG PET positive sarcoidosis. Especially in pulmonary disease, high (18)F-FDG PET SUVmax values at treatment initiation predict clinically relevant lung function improvement. These results suggest that inclusion of (18)F-FDG PET is useful in therapeutic decision-making in complex sarcoidosis.
Interstitial Lung Diseases Centre of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands Both authors contributed equally.
Adriane D M
AD
Vorselaars
Interstitial Lung Diseases Centre of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands Dept of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands Both authors contributed equally.
Heleen A
HA
Crommelin
Dept of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands.
Vera H M
VH
Deneer
Dept of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands.
Bob
B
Meek
Dept of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands.
Anke M E
AM
Claessen
Dept of Nuclear Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
Ruth G M
RG
Keijsers
Interstitial Lung Diseases Centre of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands.
Coline H M
CH
van Moorsel
Interstitial Lung Diseases Centre of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands j.grutters@antoniusziekenhuis.nl.
Jan C
JC
Grutters
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000737:chemistry; D006801:Humans; D007249:Inflammation; D000069285:Infliximab / Q000627:therapeutic use*; D008168:Lung / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D017565:Sarcoidosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D019788:Fluorodeoxyglucose F18; D000069285:Infliximab