Infliximab therapy in pulmonary fibrosis associated with collagen vascular disease

• Published in: Clinical and experimental rheumatology Vol. 25; no. 1; pp. 23 - 28
• Main Authors: ANTONIOU, K. M, MAMOULAKI, M, MALAGARI, K, KRITIKOS, H. D, BOUROS, D, SIAFAKAS, N. M, BOUMPAS, D. T
• Format: Journal Article
• Language: English
• Published: Pisa Clinical and Experimental Rheumatology 2007
• Subjects: Aged; Antibodies, Monoclonal - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Biological and medical sciences; Diseases of the osteoarticular system; Female; Humans; Inflammatory joint diseases; Infliximab; Male; Medical sciences; Middle Aged; Pneumology; Pulmonary Fibrosis - diagnostic imaging; Pulmonary Fibrosis - drug therapy; Pulmonary Fibrosis - etiology; Radiography; Respiratory Function Tests; Respiratory system : syndromes and miscellaneous diseases; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Scleroderma, Systemic - complications; Treatment Outcome; Skin disease; Diseases of the osteoarticular system; Cardiovascular disease; Autoimmune disease; Inflammatory joint disease; Monoclonal antibody; Vascular disease; Infliximab; Anticytokine; Systemic disease; Scleroderma; Tumor necrosis factor α; Immunopathology; Lung disease; Connective tissue disease; Respiratory disease; Cytokine; Immunomodulator; Chronic; Pulmonary fibrosis; Treatment; Collagen; Rheumatoid arthritis; collagen vascular disease; Immunosuppressive agent
• ISSN: 0392-856X; 1593-098X

To study the potential effectiveness of tumor necrosis factor a (TNF-alpha) inhibitor treatment for pulmonary fibrosis associated with a collagen vascular disease, CVD (rheumatoid arthritis, RA and systemic sclerosis, SSc) refractory to conventional treatment. Four patients (three men with RA, one woman with SSc) were treated with infliximab. All patients received 3mg/kgr of infliximab at intervals 0, 2 and 6 weeks, and then maintenance infusions every 8 weeks afterwards for at least a 12-month period. Patients had active disease despite treatment with corticosteroids and other immunomodulatory agents. Treatment was well-tolerated from all patients. Pulmonary fibrosis remained stable during treatment in terms of symptoms, pulmonary function tests (PFTs) and High resolution computed tomography (HRCT) appearance. As expected, a clinical response was observed in joint symptoms in patients with RA as evaluated by the DAS28 (Disease Activity Score, the 28 joint version). This study suggests that inhibition of TNF-alpha with infliximab may stabilize the progression of pulmonary fibrosis associated with CVD. Prospective, controlled trials are necessary to determine the efficacy of infliximab in pulmonary fibrosis associated CVD.