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Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis

BACKGROUND: Infliximab is a monoclonal antibody that binds and neutralizes circulating tumor necrosis factor-alpha, a key inflammatory cytokine in the pathophysiology of sarcoidosis. Despite the paucity of randomized clinical trials, infliximab is often considered a therapeutic option for refractory...

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Autores principales: Sakkat, Abdullah, Cox, Gerard, Khalidi, Nader, Larche, Maggie, Beattie, Karen, Renzoni, Elisabetta A., Morar, Nilesh, Kouranos, Vasilis, Kolb, Martin, Hambly, Nathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8905837/
https://www.ncbi.nlm.nih.gov/pubmed/35264154
http://dx.doi.org/10.1186/s12931-022-01971-5
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author Sakkat, Abdullah
Cox, Gerard
Khalidi, Nader
Larche, Maggie
Beattie, Karen
Renzoni, Elisabetta A.
Morar, Nilesh
Kouranos, Vasilis
Kolb, Martin
Hambly, Nathan
author_facet Sakkat, Abdullah
Cox, Gerard
Khalidi, Nader
Larche, Maggie
Beattie, Karen
Renzoni, Elisabetta A.
Morar, Nilesh
Kouranos, Vasilis
Kolb, Martin
Hambly, Nathan
author_sort Sakkat, Abdullah
collection PubMed
description BACKGROUND: Infliximab is a monoclonal antibody that binds and neutralizes circulating tumor necrosis factor-alpha, a key inflammatory cytokine in the pathophysiology of sarcoidosis. Despite the paucity of randomized clinical trials, infliximab is often considered a therapeutic option for refractory disease. Our study aimed to investigate the effectiveness of infliximab in patients with refractory sarcoidosis. METHODS: Sarcoidosis patients from three tertiary centres were retrospectively identified by pharmacy records based on treatment with infliximab. Treatment with Infliximab was initiated in patients who failed first and second line immunomodulators as determined by a multidisciplinary team of Respirologists, Dermatologists, ENT specialists, Rheumatologists, and Neurologists. Participants were characterized by the primary organ for which infliximab was initiated and the total number of organs involved. Clinical outcomes were categorized as treatment success versus failure. We defined treatment success as (A) improvement of cutaneous, upper airway, lymph node, gastrointestinal, eye, or joint manifestations; or (B) improvement or no change in central nervous system (CNS) or pulmonary manifestations. RESULTS: 33 patients with refractory sarcoidosis were identified. The proportion of treatment success was 100% (95% CI 54.1–100) in CNS, 91.7% (95% CI 61.5–99.8) in cutaneous, 78.6% (95% CI 49.2–95.3) in pulmonary and 71.5% (95% CI 29.0–96.3) in upper airway disease. The use of infliximab was associated with a reduction prednisone dose by 50%. CONCLUSION: Infliximab is possibly an effective therapy for refractory sarcoidosis, with the greatest value in neurologic and cutaneous manifestations. Across all disease presentations, infliximab facilitated a clinically relevant reduction in corticosteroid dose. Relapse is common after discontinuation of infliximab.
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spelling pubmed-89058372022-03-18 Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis Sakkat, Abdullah Cox, Gerard Khalidi, Nader Larche, Maggie Beattie, Karen Renzoni, Elisabetta A. Morar, Nilesh Kouranos, Vasilis Kolb, Martin Hambly, Nathan Respir Res Research BACKGROUND: Infliximab is a monoclonal antibody that binds and neutralizes circulating tumor necrosis factor-alpha, a key inflammatory cytokine in the pathophysiology of sarcoidosis. Despite the paucity of randomized clinical trials, infliximab is often considered a therapeutic option for refractory disease. Our study aimed to investigate the effectiveness of infliximab in patients with refractory sarcoidosis. METHODS: Sarcoidosis patients from three tertiary centres were retrospectively identified by pharmacy records based on treatment with infliximab. Treatment with Infliximab was initiated in patients who failed first and second line immunomodulators as determined by a multidisciplinary team of Respirologists, Dermatologists, ENT specialists, Rheumatologists, and Neurologists. Participants were characterized by the primary organ for which infliximab was initiated and the total number of organs involved. Clinical outcomes were categorized as treatment success versus failure. We defined treatment success as (A) improvement of cutaneous, upper airway, lymph node, gastrointestinal, eye, or joint manifestations; or (B) improvement or no change in central nervous system (CNS) or pulmonary manifestations. RESULTS: 33 patients with refractory sarcoidosis were identified. The proportion of treatment success was 100% (95% CI 54.1–100) in CNS, 91.7% (95% CI 61.5–99.8) in cutaneous, 78.6% (95% CI 49.2–95.3) in pulmonary and 71.5% (95% CI 29.0–96.3) in upper airway disease. The use of infliximab was associated with a reduction prednisone dose by 50%. CONCLUSION: Infliximab is possibly an effective therapy for refractory sarcoidosis, with the greatest value in neurologic and cutaneous manifestations. Across all disease presentations, infliximab facilitated a clinically relevant reduction in corticosteroid dose. Relapse is common after discontinuation of infliximab. BioMed Central 2022-03-09 2022 /pmc/articles/PMC8905837/ /pubmed/35264154 http://dx.doi.org/10.1186/s12931-022-01971-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Sakkat, Abdullah
Cox, Gerard
Khalidi, Nader
Larche, Maggie
Beattie, Karen
Renzoni, Elisabetta A.
Morar, Nilesh
Kouranos, Vasilis
Kolb, Martin
Hambly, Nathan
Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis
title Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis
title_full Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis
title_fullStr Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis
title_full_unstemmed Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis
title_short Infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis
title_sort infliximab therapy in refractory sarcoidosis: a multicenter real-world analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8905837/
https://www.ncbi.nlm.nih.gov/pubmed/35264154
http://dx.doi.org/10.1186/s12931-022-01971-5
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