Jounieaux F, Chapelon C, Valeyre D, Israel Biet D, Cottin V, Tazi A, Fournier E, Wallaert B
Service de pneumologie et immuno-allergologie, clinique des maladies respiratoires, centre de compétence des maladies pulmonaires rares, hôpital Albert-Calmette, CHRU de Lille, boulevard du Pr-Leclercq, 59037 Lille cedex, France.
Rev Mal Respir. 2010 Sep;27(7):685-92. doi: 10.1016/j.rmr.2010.06.011. Epub 2010 Jul 31.
The management of chronic forms of sarcoidosis can be a difficult therapeutic problem. The purpose of this observational study was to analyze the effectiveness and tolerance of infliximab in chronic sarcoidosis. This multicentre retrospective study involved 31 cases of chronic, systemic, and/or pulmonary sarcoidosis treated by infliximab. Disease had been present for 9 years and involved a mean of four organs. Patients had received several immunosuppressive drugs and 30/31 were treated with corticosteroids (19 ± 16 mg prednisone/day) with the addition in 17 cases, of one or more other immunosuppressive agents. The duration of infliximab therapy was 13 ± 12 months. A beneficial response to infliximab was observed in 62% of the cases across all organs involved: 65% for lung involvement, 67% for skin lesions and 50% for central nervous system lesions. For other organs, responses were disparate. The corticosteroid sparing effect was small (2.8 ± 9.7 mg/day). Effectiveness was more frequent in patients who were treated with additional immunosuppressive agents. Thirteen (41.9%) patients developed side effects; in seven out of 13, side effects were severe, sometimes requiring infliximab to be stopped. Our study supports the continuing interest in the use of infliximab for the treatment of chronic sarcoidosis, but also highlights the frequency and severity of side effects. Indications are difficult to specify, and currently, its use should be restricted to clinical trials.
结节病慢性形式的管理可能是一个棘手的治疗难题。这项观察性研究的目的是分析英夫利昔单抗治疗慢性结节病的有效性和耐受性。这项多中心回顾性研究纳入了31例接受英夫利昔单抗治疗的慢性、全身性和/或肺部结节病患者。疾病已存在9年,平均累及4个器官。患者曾接受过多种免疫抑制药物治疗,31例中有30例接受了皮质类固醇治疗(泼尼松19±16毫克/天),其中17例还加用了一种或多种其他免疫抑制药物。英夫利昔单抗治疗持续时间为13±12个月。在所有受累器官中,62%的病例对英夫利昔单抗有良好反应:肺部受累为65%,皮肤病变为67%,中枢神经系统病变为50%。对于其他器官,反应各不相同。皮质类固醇减量效果较小(2.8±9.7毫克/天)。在加用其他免疫抑制药物治疗的患者中,有效性更常见。13例(41.9%)患者出现了副作用;13例中有7例副作用严重,有时需要停用英夫利昔单抗。我们的研究支持继续关注使用英夫利昔单抗治疗慢性结节病,但也强调了副作用的发生率和严重性。适应证难以明确,目前,其使用应限于临床试验。