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.
|
Authors | Adriane D M Vorselaars, Heleen A Crommelin, Vera H M Deneer, Bob Meek, Anke M E Claessen, Ruth G M Keijsers, Coline H M van Moorsel, Jan C Grutters |
Journal | The European respiratory journal
(Eur Respir J)
Vol. 46
Issue 1
Pg. 175-85
(Jul 2015)
ISSN: 1399-3003 [Electronic] England |
PMID | 25929955
(Publication Type: Clinical Study, Journal Article, Research Support, Non-U.S. Gov't)
|
Copyright | Copyright ©ERS 2015. |
Chemical References |
- Anti-Inflammatory Agents
- Fluorodeoxyglucose F18
- Infliximab
|
Topics |
- Aged
- Anti-Inflammatory Agents
(therapeutic use)
- Female
- Fluorodeoxyglucose F18
(chemistry)
- Humans
- Inflammation
- Infliximab
(therapeutic use)
- Lung
(drug effects)
- Male
- Middle Aged
- Positron-Emission Tomography
- Prospective Studies
- Quality of Life
- Respiratory Function Tests
- Sarcoidosis, Pulmonary
(diagnostic imaging, drug therapy)
- Treatment Outcome
|