PT  - JOURNAL ARTICLE
AU  - Adriane DM Vorselaars
AU  - Heleen A Crommelin
AU  - Vera HM Deneer
AU  - Bob Meek
AU  - Anke ME Claessen
AU  - Ruth GM Keijsers
AU  - Coline HM van Moorsel
AU  - Jan C Grutters
TI  - Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis
AID  - 10.1183/09031936.00227014
DP  - 2015 Apr 30
TA  - European Respiratory Journal
PG  - ERJ-02270-2014
4099  - http://erj.ersjournals.com/content/early/2015/04/29/09031936.00227014.short
4100  - http://erj.ersjournals.com/content/early/2015/04/29/09031936.00227014.full
AB  - 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 18F-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 18F-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 18F-FDG PET positive sarcoidosis. Especially in pulmonary disease, high 18F-FDG PET SUVmax values at treatment initiation predict clinically relevant lung function improvement. These results suggest that inclusion of 18F-FDG PET is useful in therapeutic decision-making in complex sarcoidosis. Infliximab is highly effective in refractory 18F-FDG PET positive sarcoidosis patients http://ow.ly/JoxhL