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Infliximab Successfully Treats a Case of Resistant Sarcoidosis
A DGReview of :"Successful tumor necrosis factor alpha blockade treatment in therapy-resistant sarcoidosis"
Arthritis & Rheumatism
01/08/2004
By Emma Hitt, PhD
Tumour necrosis factor (TNF)-alpha blockade with infliximab successfully treated a patient with therapy-resistant severe sarcoidosis.
Sarcoidosis is a multisystemic disorder of unknown aetiology characterised by a noncaseating granulomatous inflammation. TNF-alpha seems to play a crucial role, and elevated concentrations of this cytokine have been detected in patients with this condition.
Until now, only 1 case has been published of sarcoidosis successfully treated with infliximab, a chimeric human-murine anti-TNF-alpha monoclonal antibody.
Kai U. Ulbricht, MD, and colleagues, Hannover Medical School, Germany, describe a patient with severe sarcoidosis involving the lung and liver.
The patient was a 51-year-old woman with a 4-year history of multiorgan sarcoidosis. From 1999 to 2002, she was treated with various regimens including azathioprine, methotrexate, cyclophosphamide and pentoxifylline. These treatments failed to control the disease and salvage therapy was started with infliximab 3 mg/kg.
Immediately after the first course of treatment with infliximab, the patient reported decreased arthralgia, fever and dyspnoea. Joint swelling also decreased, and chest radiographs revealed a remission of the bilateral hilar lymphadenopathy and interstitial pattern.
During 10 months of follow up, arthritis remained in total clinical remission. In addition, a computed tomography scan revealed complete remission of liver lesions. Subsequently, the corticosteroid dose was tapered with no need for additional immunosuppressive treatment.
"To our knowledge, this is the first reported case of successful treatment of multiorgan sarcoidosis that was previously resistant to conventional therapy," Dr. Ulbricht and colleagues note. "TNF-alpha blockade seems to be a potential therapeutic alternative for use in otherwise therapy-resistant, severe sarcoidosis."
Arthritis Rheum 2003;48:3542-3543.
"Successful tumor necrosis factor alpha blockade treatment in therapy-resistant sarcoidosis"
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