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

Abstract

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.

Epidemiology, clinical presentation, treatment, and outcome of neurosarcoidosis: A mono-centric retrospective study and literature review

“…Our literature search identified 776 articles of which 741 were excluded after abstracts and full-text records screening ( Figure 1 ). Thirty-five articles met our inclusion criteria, including 1,793 patients diagnosed with neurosarcoidosis from 1995 to 2021 ( 7 , 16 , 19 – 53 ). Only three (9%) studies were prospective ( 33 , 36 , 48 ) and 14 (40%) were multicentric ( 16 , 19 , 22 , 24 – 26 , 29 , 30 , 32 , 35 , 39 , 40 , 43 , 45 ) ( Supplementary Table 2 ).…”

“…Based on the role of tumor necrosis factor-alpha (TNF-α) in autoimmune disease, anti-TNF-α monoclonal antibodies have been used as a novel therapeutic approach and are associated with favorable results in many diseases such as rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease, and non-infectious uveitis ( 18 ), as well as in systemic sarcoidosis ( 19 – 23 ). Recent studies provided class IV evidence that TNF-α antagonists are also beneficial in neurosarcoidosis ( 16 , 24 – 26 ).…”

Pulmonale Sarkoidose

“…Als weitere Therapieeskalation bei unzureichender Wirkung von MTX oder Azathioprin werden inzwischen TNF-α-Blocker, allen voran Infliximab, empfohlen. Auch hier haben eine Vielzahl von Publikationen in den vergangenen Jahren die Evidenz für deren Einsatz verbessert [51][52][53][54][55]. Allerdings sind die meisten Daten retro spektive Fallserien, mit jedoch teilweise großen Fallzahlen (Jamilloux n = 132) [54].…”

Cryobiopsy for pneumonitis diagnosis in NSCLC immunotherapy

“…Non-small cell lung cancer is still diagnosed at advanced stage and systemic treatment administration is required. We have nowadays novel tools for the diagnosis and staging of lung cancer like radial-ebus, electromagnetic navigation and convex probe-ebus [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ]. However; we still need a successful lung cancer screening program for early lung cancer diagnosis [ 9 ].…”

“…In very severe cases the patient has to stop the treatment and switch to another treatment modality. Regarding colitis [ 19 ],thyroiditis and hepatitis monoclonal antibodies have been administered in severe cases like infliximab, while for pneumonitis cortisone in different dosages [ 20 , 21 ]. Usually NSCLC patients are having positron emission computed tomography (PET-CT) for initial staging and restaging.…”