TY - JOUR T1 - Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis JF - European Respiratory Journal JO - Eur Respir J SP - 175 LP - 185 DO - 10.1183/09031936.00227014 VL - 46 IS - 1 AU - Adriane D.M. Vorselaars AU - Heleen A. Crommelin AU - Vera H.M. Deneer AU - Bob Meek AU - Anke M.E. Claessen AU - Ruth G.M. Keijsers AU - Coline H.M. van Moorsel AU - Jan C. Grutters Y1 - 2015/07/01 UR - http://erj.ersjournals.com/content/46/1/175.abstract N2 - 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 ER -