The potential additional benefit of infliximab in patients with chronic pulmonary sarcoidosis already receiving corticosteroids: A retrospective analysis from a randomized clinical trial

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• 作者：Marc A. Judson ; Robert P. Baughman ; Ulrich Costabel ; Michael Mack ; Elliot S. Barnathan
• 关键词：Sarcoidosis ; Pulmonary ; Corticosteroids ; Infliximab ; Treatment
• 刊名：Respiratory Medicine
• 出版年：January, 2014
• 年：2014
• 卷：108
• 期：1
• 页码：189-194
• 全文大小：453 K

文摘

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Summary

Background

Infliximab, a TNF-alpha antagonist, has shown efficacy in the treatment of sarcoidosis. Since corticosteroids inhibit TNF-alpha expression, we postulated that sarcoidosis patients receiving a sufficient corticosteroid dose may have an attenuated response to the addition of infliximab.

Methods

We analyzed data from a previous randomized double blind prospective trial of infliximab versus placebo for chronic pulmonary sarcoidosis. The effect of the maintenance corticosteroid dose on the change in FVC % predicted between 0 and 24 weeks (螖FVC%pred0-24) was analyzed in two ways. First, the mean 螖FVC%pred0-24 was calculated for the placebo and infliximab groups using three different daily prednisone equivalent dose thresholds: a) <10聽mg versus 鈮?0聽mg; b) <15聽mg versus 鈮?5聽mg; c) <20聽mg versus 鈮?0聽mg. Second, in both the placebo and infliximab groups, a correlation coefficient was calculated between the maintenance corticosteroid dose and 螖FVC%pred0-24.

Results

Both the group that received infliximab and either a maintenance daily dose of <10聽mg of prednisone and the group receiving 鈮?0聽mg had a significant increase in FVC%pred0-24. However, both the groups that received infliximab and a corticosteroid dose of >15聽mg of prednisone and 鈮?0聽mg of prednisone did not demonstrate a significant 螖FVC%pred0-24. For the placebo group, there was no significant correlation between the corticosteroid dose and the 螖FVC%pred0-24. For the infliximab group, there was a significant correlation (m>pm>聽=聽0.0097) between higher corticosteroid dose and less improvement in FVC%pred0-24.

Conclusion

Our results suggest that infliximab adds minimal potential benefit to corticosteroids for pulmonary sarcoidosis at doses above 15-20聽mg/day of prednisone.