Infliximab for treating sarcoidosis patients, Portuguese experience

• Published in: Revista portuguesa de pneumologia (English ed.) Vol. 17; no. 2; pp. 85 - 93
• Main Authors: Aguiar, M, Marçal, N, Mendes, A.C, Bugalho de Almeida, A
• Format: Journal Article
• Language: English
• Published: Elsevier España 01.03.2011
• Subjects: Infl iximab; Internal Medicine; Pulmonary/Respiratory; Sarcoidose; Sarcoidosis; Infl iximab; Sarcoidosis; Sarcoidose
• ISSN: 2173-5115; 2173-5115
• DOI: 10.1016/S2173-5115(11)70020-3

Abstract Despite aggressive treatment, sarcoidosis may be debilitating and progressive. The role of tumor necrosis factor (TNF) ap in the genesis of granulomas is ambiguous. It has proved to be critical in the formation and maintenance of granulomatous inflammation and its antagonist, Infl iximab, has therefore been used with success in the treatment of patients with sarcoidosis. There are, however, reports of onset of sarcoidosis in patients treated for other conditions and where there had been no outbursts before submission to this therapy. We used Infl iximab in the treatment of patients with sarcoidosis who either had not responded to corticosteroids and other conventional drugs or had developed unacceptable side effects to these drugs. The initial dose was 5 mg/kg body weight and subsequent doses were given at weeks 2, 4 and then every other 8 weeks for a total period of one year. We treated ten patients with biopsy proven sarcoidosis, five men and five women, with a mean age of 47.1 years ranging from 28 to 63 years of age. Three patients had severe neurological symptoms, two had hepatic cirrhosis, one had granulomatous inflammation of the lachrymal gland and had already undergone repeated surgery, one had extensive pulmonary involvement (stage III), one had disfiguring lupus pernio and two presented disabling cutaneous nodules. Eight patients had more than one organ with evidence of disease. All patients were submitted to at least seven infusions of Infliximab. In four patients the dosage of corticosteroids or other immunosuppressive drugs was suspended, in three the dosage was reduced and in one, corticosteroids were added to the Infl iximab therapy. In five of the patients there was an important improvement. One of the patients with neurological symptoms displayed a complete recovery, while another had significant improvement of vision deficit enabling her to read again. Two patients withdrew from therapy, one due to lack of improvement of neurological symptoms and the other due to the onset of organizing pneumonia spawned by Infl iximab. Two patients developed anti-histone antibodies during treatment.Infl iximab seems effective in treating patients who are either resistant or develop side effects to a standard regimen of corticosteroids and immunosuppressive agents. These patients, treated with Infl iximab, should be under tight surveillance in order to quickly identify possible secondary effects.