Efficacy and safety of infliximab biosimilar Inflectra ^® in severe sarcoidosis

Background: Infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNF-α) is effective third-line therapy in severe sarcoidosis. The originator product of Infliximab, Remicade ^® , is expensive, limiting universal access. Recently, a less expensive biosimilar of infliximab, Inflectra ^® , has become available, but the efficacy and tolerability has not been studied in sarcoidosis. Methods: In this retrospective cohort study, 29 patients treated with the infliximab biosimilar Inflectra ^® , were analysed. Patients received Inflectra ^® intravenously monthly at a dose of 5 mg/kg. We measured trough levels before every infusion. Before and after 6 months of induction therapy pulmonary function and disease activity were evaluated using Standardised Uptake Value (SUV) of the ¹⁸ F-fluorodeoxyglucose by positron emission tomography ( ¹⁸ F-FDG PET), soluble interleukin-2 receptor (sIL-2R), angiotensin converting enzyme (ACE) and health-related quality of life (HRQOL). Results: In patients with pulmonary sarcoidosis as main treatment indication (n = 15) the predicted FVC improved with 8.1%, p < 0.05. Furthermore, in the whole group HRQoL improved significantly (p < 0.001), whereas SUVmax and sIL-2R significantly reduced (p < 0.001 and p = 0.001 respectively). Hospitalisation due to infections occurred in four patients. None of the patients discontinued Inflectra ^® due to side-effects. Furthermore, all patients had detectable trough levels indicating development of neutralizing antibodies. Conclusion: Infliximab biosimilar Inflectra ^® seems effective in the treatment of refractory sarcoidosis with a comparable safety profile to the reference product Remicade ^® . Inflectra ^® can be considered as an alternative and less expensive option for patients with refractory sarcoidosis.