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Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis.

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.
AuthorsAdriane 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
JournalThe European respiratory journal (Eur Respir J) Vol. 46 Issue 1 Pg. 175-85 (Jul 2015) ISSN: 1399-3003 [Electronic] England
PMID25929955 (Publication Type: Clinical Study, Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright ©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

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