TY - JOUR
T1 - Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis
AU - Vorselaars, Adriane D.M.
AU - Crommelin, Heleen A.
AU - Deneer, Vera H.M.
AU - Meek, Bob
AU - Claessen, Anke M.E.
AU - Keijsers, Ruth G.M.
AU - Van Moorsel, Coline H.M.
AU - Grutters, Jan C.
PY - 2015/1/1
Y1 - 2015/1/1
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.
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.
UR - http://www.scopus.com/inward/record.url?scp=84937412017&partnerID=8YFLogxK
U2 - 10.1183/09031936.00227014
DO - 10.1183/09031936.00227014
M3 - Article
C2 - 25929955
AN - SCOPUS:84937412017
SN - 0903-1936
VL - 46
SP - 175
EP - 185
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 1
ER -