A New Anti-Inflammatory Therapy (Infliximab) for Complicated Sarcoidosis

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The summary below is from the full report titled "Treatment of Complicated Sarcoidosis with Infliximab Anti–Tumor Necrosis Factor- Therapy." It is in the 3 July 2001 issue of Annals of Internal Medicine (volume 135, pages 27-31). The authors are AMF Yee and MB Pochapin.

What is the problem and what is known about it so far?

Sarcoidosis is a disease of unknown cause that produces chronic inflammation in many different organs of the body. The disease can appear in several ways, but it most often damages the lungs. Tissue samples from patients with sarcoidosis show a typical appearance under a microscope. Although mild cases of the disease frequently get better without treatment, severe cases often require treatment with corticosteroid medications. Inflammation in sarcoidosis involves the accumulation of tiny collections of cells (known as noncaseating granulomas) throughout the affected tissue. One of the cell types in these granulomas is known as a macrophage. Macrophages produce a chemical called tumor necrosis factor- (TNF-) that may accelerate the inflammatory process. Corticosteroids decrease the production of TNF-. Unfortunately, corticosteroid treatment does not always work and may have many toxic side effects. Alternative treatments for sarcoidosis would therefore be very helpful. A new pharmaceutical agent, infliximab, is a human-made antibody (antibodies are substances that the body usually uses to fight off infection) that specifically blocks the effect of TNF-.

Why did the researchers do this particular study?

The researchers wanted to see if infliximab could be used effectively to treat a patient with sarcoidosis who did not respond to corticosteroids.

Who was studied?

A 72-year-old woman with severe diarrhea, nodules in her lungs, enlarged lymph nodes, and abnormalities in her muscles. The patient underwent biopsies, and the tissue samples showed changes in tissue appearance that are typical of sarcoidosis. Despite corticosteroid therapy, the patient's illness got worse.

How was the study done and what did the researchers find?

Nine months after the onset of her illness, after corticosteroids had failed to produce improvement, the patient was given a dose of infliximab. Within 2 days, the woman's muscle strength increased, and within 1 week, her diarrhea improved; the lung nodules went away completely. However, after the third dose of infliximab, abnormal blood clots formed. Although it was unclear whether infliximab contributed to this complication, the therapy was discontinued. Soon afterward, soft bowel movements returned. The patient then received another drug (thalidomide) that relieved her symptoms.

What were the limitations of the study?

Only one patient was studied, and she did not have the typical clinical pattern of sarcoidosis (which usually affects the lung more than the bowel). Infliximab seems to have worked through its action against TNF-; however, the authors cannot be certain of this.

What are the implications of the study?

Infliximab may be useful in treating sarcoidosis that does not respond to corticosteroid therapy.