RESEARCH - Remicade efficacy and safety against refractory systemic necrotizing vasculitides: long-term follow-up of 15 patients

[Guest guest]

Ann Rheum Dis. Published Online First: 29 April 2008.

doi:10.1136/ard.2007.083584

Copyright © 2008 BMJ Publishing Group Ltd & European League Against

Rheumatism

--------------------------------------------------------------------------------

Concise Report

Infliximab efficacy and safety against refractory systemic necrotizing

vasculitides: long-term follow-up of 15 patients

L Josselin 1, A Mahr 1, P Cohen 1, C Pagnoux 1, G Guaydier-Souquières

2, G Hayem 3, C Job-Deslandre 1, F Lifermann 4, J Pourrat 5 and L

Guillevin 1*

1 Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, France

2 Centre Hospitalier Universitaire Côte-de-Nacre, Caen, France

3 Bichat Hospital, France

4 Hôpital de Dax, Dax, France

5 Hôpital Purpan, Toulouse, France

Abstract

Background: Results of uncontrolled studies suggested infliximab

efficacy against systemic necrotizing vasculitides (SNV) refractory to

conventional therapy. However, its safety and ability to induce and

maintain remission over the long term remain unknown. Objectives: To

report our experience using infliximab to treat refractory SNV,

focusing on the patients' longer-term outcomes.

Methods: The medical charts of patients given adjunctive infliximab

for refractory SNV 2 years before this evaluation were reviewed

retrospectively.

Results: The 15 patients (median age: 46 [range 20–69] years; median

follow-up: 35 [24–41] months) included 10 with Wegener's

granulomatosis, 1 microscopic polyangiitis, 3 rheumatoid

arthritis-associated and 1 cryoglobulinemia-related vasculitides.

Median time on infliximab was 8 [2–31] months; 2 patients are still

being treated. By day 45, 11 patients had entered remission (BVAS=0)

and 4 others had responded (BVAS decrease 50%). Five patients achieved

sustained remissions (6 months, corticosteroids 7.5 mg/day). Thirteen

stopped infliximab because of loss of efficacy (n=4), remission (n=6),

or non-compliance, chest tightness or side effect (1 each). Ten

patients relapsed (median interval: 13 months), 3 while still

receiving infliximab; 2 were successfully retreated with infliximab.

Conclusion: These observations highlight infliximab as a potentially

useful and safe salvage therapy for patients with refractory SNV.

http://ard.bmj.com/cgi/content/abstract/ard.2007.083584v1?papetoc

--

Not an MD