Remicade effective for sarcoidosis of nerves or liver, not muscles and skin
Even when patients did respond, the therapy 'merely suspended' disease
Treatment with Remicade (infliximab) is generally effective for controlling sarcoidosis when it affects the nervous system or liver, but patients whose disease affects the skin or skeletal system aren’t as likely to respond to it, a study reports.
“[Remicade] shows promise for treating patients with sarcoidosis, particularly with [nervous system] and liver involvement, but not musculoskeletal or cutaneous [skin] involvement,” researchers wrote in “Efficacy and safety of Infliximab in systemic sarcoidosis according to GenPhenReSa organ-involvement phenotype: a retrospective study of 55 patients,” which was published in Respiratory Research.
Sarcoidosis is marked by abnormal clumps of inflammatory immune cells, called granulomas, that can affect various organs. Remicade is approved for several inflammatory diseases, including sarcoidosis, and reduces inflammation by blocking the activity of TNF-alpha, an inflammatory signaling molecule.
Remicade is usually not a first choice of treatment for sarcoidosis because it can increase the risk of serious infections, but it can provide powerful disease control for some patients. Here, scientists in France reviewed data from 55 sarcoidosis patients treated with Remicade at their center to understand which patients tended to have the best response to it.
Rating the response to Remicade
About half (45%) the patients had a complete response to treatment, meaning their symptoms were entirely absent with minimal need for other medicines. Another 25% had a partial response, wherein their symptoms eased, but didn’t disappear. The remaining 30% didn’t respond.
The researchers were particularly interested in response rates according to a classification system called the Genotype-Phenotype Relationship in Sarcoidosis (GenPhenReSa) project. Proposed in 2018, it divides sarcoidosis into five types based on which organs are affected.
Here, nine patients were classified as GenPhenReSa group 1, wherein the disease mainly affects abdominal organs like the liver and spleen. There were 21 patients in GenPhenReSa group 2, where the nervous system and/or heart, among other organs, are affected.
Patients in these groups were very likely to respond to Remicade. In group 1, 77% responded, with four having a complete response. In group 2, 90% responded, with two-thirds (67%) seeing a complete response. All the patients with neurosarcoidosis, where the nerves are affected, responded to Remicade.
The study also included nine patients classified as GenPhenReSa group 4, meaning the lungs were most impacted, along with six patients in group 5, which is a bit of a catch-all for patients who don’t neatly fit into any of the other groups. In these groups, about two-thirds of patients responded to Remicade.
The remaining 10 patients were classified as GenPhenReSa group 3, meaning the disease mainly affects the skin, muscles, and skeletal system. Response rates in this group were notably lower than the other groups; only three patients had any response to Remicade.
“[Remicade] was less efficacious for treating joint, muscle, or skin lesions of the patients in group 3,” wrote the researchers, who noted the study was limited to a small number of patients at one center, so the results should be interpreted cautiously.
Even when patients did respond to Remicade, the therapy “merely suspended sarcoidosis,” that is, most patients who stopped taking it had a relapse within a few months. Consistent with the therapy’s known safety profile, the researchers noted that serious infections were common, especially in older patients, including two cases of pneumonia that were fatal.
Given these risks, the scientists emphasized a need for more research to help determine the risk of a relapse after stopping Remicade. “It can cause serious infections and only suspends sarcoidosis; therefore, predictive factors for relapse should be the focus of further research,” they wrote.
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