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Rivière E, Jourde W, Gensous N, Demant X, Ribeiro E, Duffau P, Mercié P, Viallard JF, Lazaro E. Efficacy and safety of Infliximab in systemic sarcoidosis according to GenPhenReSa organ-involvement phenotype: a retrospective study of 55 patients. Respir Res 2024; 25:124. [PMID: 38486260 PMCID: PMC10941530 DOI: 10.1186/s12931-024-02758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Infliximab is currently recommended as a third-line treatment for refractory sarcoidosis. Data in function of clinical phenotype are currently lacking. We evaluated patients' characteristics and responses to infliximab according to their GenPhenReSa cluster. METHODS We evaluated clinical and biological characteristics of patients diagnosed with sarcoidosis who received infliximab between September 2008 and April 2019 at our centre. RESULTS Fifty-five patients (median disease duration, 87 months) received infliximab: 48 (87%) as a second- or third-line treatment, and 7 (13%) as a first-line treatment. After a median duration of 12 months, 24 (45%) and 14 (25%) patients achieved complete and partial responses, respectively, together with a significant decrease in the number of affected organs and tapering of steroid doses. All patients with neurosarcoidosis (OR 17), 90% in group 2 (ocular-cardiac-cutaneous-CNS, OR 7.4), and approximately two-thirds of those in groups 1 (abdominal organs), 4 (pulmonary-lympho-nodal), and 5 (extrapulmonary), achieved a response, whereas patients in group 3 (musculoskeletal-cutaneous) had a treatment-failure OR of 9. Infliximab could be stopped after complete remission was achieved in 7 patients: 4 relapsed after a median of 6 months. Overall, 36% of patients experienced serious adverse events, mainly infections, which led to treatment cessation in 29% of patients and caused two deaths. CONCLUSIONS Other than patients with musculoskeletal-cutaneous involvement (group 3), infliximab led to a good response for patients with CNS (group 2) and liver (group 1) organ-predominant sarcoidosis. However, it led to serious infections and merely suspended sarcoidosis, so further research on factors predictive of relapse is needed.
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Affiliation(s)
- Etienne Rivière
- Internal Medicine and Infectious Diseases unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33604, Pessac Cedex, France.
- INSERM U1034, Bordeaux University, F33604, Pessac Cedex, France.
| | - Wendy Jourde
- Internal Medicine and Infectious Diseases unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33604, Pessac Cedex, France
| | - Noémie Gensous
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, F33000, Bordeaux, France
- ImmunoconcEpT; FHU ACRONIM, UMR CNRS 5164, Bordeaux University, F33000, Bordeaux, France
| | - Xavier Demant
- Respiratory Diseases unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, CIC 1401, F33604, Pessac Cedex, France
| | - Emmanuel Ribeiro
- ImmunoconcEpT; FHU ACRONIM, UMR CNRS 5164, Bordeaux University, F33000, Bordeaux, France
| | - Pierre Duffau
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, F33000, Bordeaux, France
- ImmunoconcEpT; FHU ACRONIM, UMR CNRS 5164, Bordeaux University, F33000, Bordeaux, France
| | - Patrick Mercié
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, F33000, Bordeaux, France
- Univ. Bordeaux, INSERM, BRIC, U1312, F33000, Bordeaux, France
| | - Jean-François Viallard
- Internal Medicine and Infectious Diseases unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33604, Pessac Cedex, France
- INSERM U1034, Bordeaux University, F33604, Pessac Cedex, France
| | - Estibaliz Lazaro
- Internal Medicine and Infectious Diseases unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33604, Pessac Cedex, France
- ImmunoconcEpT; FHU ACRONIM, UMR CNRS 5164, Bordeaux University, F33000, Bordeaux, France
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Smedslund G, Kotar AM, Uhlig T. Sarcoidosis with musculoskeletal manifestations: systematic review of non-pharmacological and pharmacological treatments. Rheumatol Int 2022; 42:2109-2124. [PMID: 35943526 PMCID: PMC9548475 DOI: 10.1007/s00296-022-05171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
We aimed to summarise effects and use of non-pharmacological and pharmacological treatments for sarcoidosis with musculoskeletal manifestations. We systematically searched the Cochrane Library, Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, clinical.trials.gov, PROSPERO and PEDro for systematic reviews from 2014 to 2022 and for primary studies from date of inception to March 29, 2022, and studies with patients diagnosed with sarcoidosis with musculoskeletal manifestations. Inclusion criteria required that studies reported effects of non-pharmacological and/or pharmacological treatments or number of patients receiving these treatments. Results were reported narratively and in forest plots. Eleven studies were included. No systematic reviews fulfilled our inclusion criteria. None of the included studies had a control group. We found that between 23 and 100% received corticosteroids, 0-100% received NSAIDs, 5-100% received hydroxychloroquine, 12-100% received methotrexate, 0-100% received TNF inhibitors, and 3-4% received azathioprine. Only ten patients in one study had used non-pharmacological treatments, including occupational therapy, chiropractic and acupuncture. There are no controlled studies on treatment effects for patients with sarcoidosis with musculoskeletal manifestations. We found 11 studies reporting use of pharmacological treatments and only one study reporting use of non-pharmacological treatments. Our study identified major research gaps for pharmacological and non-pharmacological treatment in musculoskeletal sarcoidosis and warrant randomised clinical trials for both.
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Affiliation(s)
- Geir Smedslund
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway.
| | - Annie Martina Kotar
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway
| | - Till Uhlig
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Norwegian National Advisory Unit On Rehabilitation in Rheumatology, Oslo, Norway
- University of Oslo, Oslo, Norway
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