Pulmonary sarcoidosis: infliximab

How well does infliximab work?

Several studies have looked at how well infliximab works for treating chronic sarcoidosis in the lungs.

One study of 138 people whose condition was stable found that those who had infliximab could breathe out more air than those who had placebo (a dummy medicine). However, the average difference was small (although it could be that people with more severe illness got more benefit), and there was no convincing difference in ease of breathing. There was also no convincing difference between the groups in how far they could walk in 6 minutes or in their quality of life.

Three studies in a total of 60 people looked at how well infliximab worked for people whose condition was severe and not improving with the usual treatments, or for those who couldn't have the usual treatments. The studies compared people's breathing and quality of life before and after treatment with infliximab, rather than comparing infliximab with placebo.

In these 3 studies, people's breathing and quality of life improved with infliximab, and the improvement was greater than in the study of 138 people with a stable condition. This may be because infliximab works better in people with severe sarcoidosis that is not responding to the usual treatments. However, we don't know what would have happened to those people if they hadn't had infliximab. The 3 studies were small and of low quality, therefore, better quality evidence is needed to confirm this.

Guidelines recommend that immunosuppressants such as infliximab should be used only when sarcoidosis is getting worse, and:

What are the possible harms or side effects?

The most common side effects of infliximab (occurring in at least 1 in 10 people) include aches and pains, infections of the upper respiratory tract (such as sinusitis), viral infections (such as 'flu and herpes), headaches, stomach pains and feeling sick. People often have a reaction when infliximab is administered into their veins.

Most side effects of infliximab are mild or moderate. However, some people have serious side effects, which may need treating. In most of the studies, a few people had to stop taking infliximab because of serious side effects.

People should be tested for hepatitis B virus and tuberculosis (TB) before starting infliximab. They should also be monitored closely for infections before, during and 6 months after finishing treatment.