What is the relationship between Infliximab (Infliximab) and sarcoidosis?

From the Guidelines

Infliximab is a recommended treatment option for patients with severe or progressive sarcoidosis unresponsive to corticosteroids and conventional immunosuppressants, particularly for those with pulmonary, cutaneous, ocular, and neurosarcoidosis manifestations. The treatment algorithm for symptomatic or organ-threatening sarcoidosis, as proposed by the Delphi consensus recommendations 1, suggests adding anti-TNF-α infliximab for patients with chronic phenotype and disease progression or toxicity. The European Respiratory Society (ERS) clinical practice guidelines on treatment of sarcoidosis also recommend infliximab as a treatment option for patients with symptomatic pulmonary sarcoidosis who have been treated with glucocorticoids and have continued disease 1.

The typical dosage of infliximab is 3-5 mg/kg intravenously at weeks 0,2, and 6 for induction, followed by maintenance infusions every 4-8 weeks 1. Treatment duration varies based on clinical response, but is often continued for at least 6-12 months before considering tapering. Infliximab works by blocking tumor necrosis factor-alpha (TNF-α), a key inflammatory cytokine involved in granuloma formation in sarcoidosis.

Before initiating therapy, patients should undergo screening for latent tuberculosis, hepatitis B, and other infections, as infliximab can reactivate these conditions. Regular monitoring for adverse effects is essential, including infusion reactions, infections, and potential development of antidrug antibodies. Combination therapy with methotrexate (7.5-15 mg weekly) may reduce antibody formation and improve long-term efficacy.

Key considerations for treatment with infliximab include:

• Patient selection: Infliximab is recommended for patients with severe or progressive sarcoidosis unresponsive to corticosteroids and conventional immunosuppressants.
• Dosage and administration: The typical dosage is 3-5 mg/kg intravenously at weeks 0,2, and 6 for induction, followed by maintenance infusions every 4-8 weeks.
• Monitoring: Regular monitoring for adverse effects, including infusion reactions, infections, and potential development of antidrug antibodies, is essential.
• Combination therapy: Combination therapy with methotrexate may reduce antibody formation and improve long-term efficacy.

Overall, infliximab is a valuable treatment option for patients with severe or progressive sarcoidosis, particularly for those with pulmonary, cutaneous, ocular, and neurosarcoidosis manifestations. However, treatment decisions should be individualized based on patient-specific factors, including disease severity, organ involvement, and response to previous treatments.

From the Research

Infliximab and Sarcoidosis

• Infliximab, a tumor necrosis factor-alpha (TNF-alpha) inhibitor, has been studied as a potential treatment for sarcoidosis, particularly in cases that are refractory to classical treatment 2, 3, 4.
• The use of infliximab in sarcoidosis is based on the idea that TNF-alpha plays a role in the clinical exacerbation of the disease 4.
• Studies have shown that infliximab can be effective in treating chronic sarcoidosis, with improvements in symptoms and serum albumin levels 4.
• However, infliximab therapy can also be associated with adverse effects, such as the development of a hypercoagulable state and circulating anticardiolipin antibodies 4.
• The decision to use infliximab in sarcoidosis should be made on a case-by-case basis, taking into account the severity of the disease and the patient's response to other treatments 5, 2, 3.

Indications for Infliximab in Sarcoidosis

• Infliximab may be considered in patients with severe sarcoidosis who are refractory to classical treatment, except for those with cardiac involvement 5.
• It may also be used in patients with chronic disease who require prolonged treatment and are at risk of disabling side effects from corticosteroids 2, 3.
• The use of infliximab in sarcoidosis is not yet widely established, and more research is needed to determine its efficacy and safety in this patient population 6, 2, 3.

Administration and Monitoring of Infliximab

• Infliximab is typically administered via intravenous infusion, with a dose of 5 mg/kg of ideal body weight 4.
• The infusion is usually repeated at 2 and 6 weeks, with subsequent doses given as needed to maintain disease control 4.
• Patients receiving infliximab should be closely monitored for adverse effects, including infections, infusion reactions, and the development of autoantibodies 2, 4.