Some lines of evidence show that sarcoidosis patients refractory to first and second line
treatments may benefit from inhibition of tumor necrosis factor-alpha (TNF-?) by infliximab,
however long-term follow-up studies are scare. Our aim was to assess the clinical
effectiveness of infliximab in refractory sarcoidosis and examine the changes laboratory
findings (blood cell counts, CRP, calcium and ACE level), lung function and imaging data.
The hospital database of our terciary reference centre for intersticial lung diseases was
retrospectively analysed.19 patients (9 women, 10 men) were identified with refractory
sarcoidosis who received infliximab treatment for at least for 3 month (longest period being
>3 years). All patients had previously received steroids or combination of steroids and
methotrexate. When using infliximab, it was well tolerated and only 6 patients maintained
their immunosuppressive agents. Infliximab treatment did not cause changes in blood cell
counts and calcium level. CRP level decreased in 74% of the patients. There was no
association between ACE level and disease activity. The mediastinal and hilar lymph nodes
showed a 56% regression with 25% regression seen in the lung parenchyma. Patients showed
a 6% improvement in FEV1 and a 6.5% improvement in FVC as the result of treatment.
Overall, the condition of 18 patients improved satisfactorily during the treatment, with high
degree of regression in radiological findings.
In conclusion, our data support that infliximab is an effective and tolerable treatment choice
for patients with refractory sarcoidosis.