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Vorselaars ADM, Crommelin HA, Deneer VHM, Meek B, Claessen AME, Keijsers RGM, van Moorsel CHM, Grutters JC. Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis. Eur Respir J 2015; 46:175-85. [PMID: 25929955 DOI: 10.1183/09031936.00227014] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/02/2015] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Adriane D M Vorselaars
- Interstitial Lung Diseases Centre of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands Both authors contributed equally
| | - Heleen A Crommelin
- 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
| | - Vera H M Deneer
- Dept of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Bob Meek
- Dept of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Anke M E Claessen
- Dept of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Ruth G M Keijsers
- Dept of Nuclear Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Coline H M 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
| | - Jan C Grutters
- 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
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Abstract
PURPOSE OF REVIEW None of the medications used in clinical practice to treat sarcoidosis have been approved by the regulatory authorities. Understanding how to use disease-modifying antisarcoid drugs, however, is essential for physicians treating patients with sarcoidosis. This review summarizes the recent studies of medications used for sarcoidosis with a focus on nonsteroidal therapies. Studies from 2006 to 2013 were considered for review to update clinicians on the most relevant literature published over the last few years. RECENT FINDINGS Several recently published pieces of evidence have helped expand our ability to more appropriately sequence second-line and third-line therapies for sarcoidosis. For instance, methotrexate and azathioprine may be useful and well tolerated medications as second-line treatment. Mycophenolate mofetil might have a role in neurosarcoidosis. TNF-α blockers and other biologics seem to be well tolerated medications for the most severely affected patients. SUMMARY Corticosteroids remain the first-line therapy for sarcoidosis as many patients never require treatment or only necessitate a short treatment duration. Second-line and third-line therapies described in this article should be used in patients with progressive or refractory disease or when life-threatening complications are evident at the time of presentation.
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Dubaniewicz A, Zimmermann A, Dudziak M, Typiak M, Skotarczak M. Tuberculosis in the course of sarcoidosis treatment: is genotyping necessary for personalized therapy? Expert Rev Clin Immunol 2014; 9:349-60. [DOI: 10.1586/eci.13.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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