From the Guidelines
Remicade (infliximab) is not considered first-line therapy for cardiac sarcoidosis, and its use should be reserved for patients who have failed or cannot tolerate corticosteroids and other immunosuppressive agents. The primary treatment for cardiac sarcoidosis remains corticosteroids like prednisone, as recommended by the European Respiratory Journal guidelines 1. Infliximab, typically administered at doses of 3-5 mg/kg intravenously every 4-8 weeks after initial loading doses, may be considered for patients with cardiac sarcoidosis who have failed or cannot tolerate other treatments, as suggested by the Delphi consensus recommendations 1. However, the evidence supporting infliximab for cardiac sarcoidosis specifically is limited, and treatment decisions should be made by a multidisciplinary team including cardiologists and pulmonologists with experience in sarcoidosis management 1. Before starting infliximab, patients must be screened for tuberculosis and hepatitis B, and should be monitored for potential side effects including infections, heart failure exacerbation, and infusion reactions. Some key points to consider when using infliximab for cardiac sarcoidosis include:
- The usual dosage is 3-5 mg/kg intravenously every 4-8 weeks after initial loading doses 1
- Major toxicities include infections, allergic reactions, and contraindications in severe congestive heart failure, prior malignancy, demyelinating neurologic disease, active tuberculosis, and deep fungal infections 1
- Recommended monitoring includes screening for prior tuberculosis, monitoring for allergic reactions, and contraindications in certain conditions 1 It is essential to weigh the potential benefits and risks of infliximab treatment for cardiac sarcoidosis and to consider the individual patient's circumstances and medical history when making treatment decisions.
From the Research
Effectiveness of Remicade for Heart Sarcoidosis
- Remicade (infliximab) has been studied as a treatment for heart sarcoidosis, with evidence suggesting its effectiveness in reducing inflammation and improving cardiac function 2, 3, 4, 5.
- A study published in the Journal of Cardiac Failure found that treatment with tumor necrosis factor alpha inhibitors, including infliximab, resulted in a significant decrease in cardiac FDG uptake and an improvement in left ventricular ejection fraction 2.
- Another study published in the International Journal of Cardiology found that infliximab treatment resulted in a reduction in inflammation on FDG-PET/CT and an improvement in LV function, without serious adverse events 3.
- A systematic review of the literature found that infliximab plays a vital role in stabilizing refractory cardiac sarcoidosis by stemming clinical deterioration, arrhythmia burden, and even reducing steroid requirements 4.
Safety and Adverse Events
- While infliximab has been shown to be effective in treating heart sarcoidosis, it is not without risks, and adverse events have been reported in some studies 2, 4, 5.
- Common adverse events include infections, and some patients may require treatment cessation due to serious side effects 2, 5.
- However, other studies have found that infliximab can be safely used in patients with heart sarcoidosis, with no significant adverse effects on cardiac function 3.
Clinical Applications
- Remicade (infliximab) may be a useful treatment option for patients with refractory cardiac sarcoidosis who have not responded to standard therapies 4, 5.
- The use of infliximab in cardiac sarcoidosis is often reserved for patients with a worsening clinical status and/or evidence of persistent inflammatory activity despite conventional therapy 4.
- Further prospective trial data is necessary to validate the findings of these studies and to fully understand the role of infliximab in the management of cardiac sarcoidosis 4.