Beneficial effect of infliximab on refractory sarcoidosis

INTRODUCTION: Sarcoidosis is a systemic granulomatous disease. Evidence suggests that tumour necrosis factor-alpha (TNF-alpha) is important in the pathophysiology, and TNF-alpha-inhibitors such as infliximab are therefore used against sarcoidosis refractory to traditional therapies or where side effects to these are intolerable. The aim of this retrospective study was to investigate the effect of infliximab on refractory sarcoidosis. MATERIAL AND METHODS: Twelve patients were treated with infliximab and their medical records were reviewed. Efficiency was evaluated based on changes in P-angiotensin-converting enzyme (P-ACE) and P-interleukin-2 (P-IL-2), pulmonary function tests and chest radiographs (stage I-IV) after seven treatments and at the end of treatment. The effect of infliximab on extrapulmonary sarcoidosis was described separately for ocular and cutaneous sarcoidosis. RESULTS: Patients with pulmonary symptoms (n = 9) obtained an average increase in forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), total lung capacity (TLC) and diffusion capacity for carbon monoxide (TLCO) after treatment with infliximab. One patient with radiographic stage I at baseline obtained a normal radiograph after treatment. Changes in radiographic staging were observed for no other patients. The mean value of both P-ACE and P-IL-2 in patients with raised values pre-treatment (n = 6) decreased to values with-in the reference interval after treatment. Furthermore, infliximab had a steroid sparing effect on ocular sarcoidosis (n = 2) and an effect on cutaneous sarcoidosis (n = 2) based on clinical evaluations. CONCLUSION: Our results suggest that infliximab is an effective treatment against refractory pulmonary and extrapulmonary sarcoidosis. Other studies have shown similar results.