PO75 - Long-term infliximab therapy in refractory pulmonary and extra-pulmonary sarcoidosis provides sustained clinical benefit
Sinead O'Bryant MD (United States)1; Joseph Barney MD (United States)2; Ishan Lalani MD (United States)2;
1 - Internal Medicine Residency Program, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA; 2 - Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA;
Keywords: Infliximab; sarcoidosis; refractory;
Select the theme: Controversies in Sarcoidosis Treatment
Type: Original Papers
Presentation: Poster Presentation

Introduction: Infliximab, a monoclonal antibody targeting tumor necrosis factor alpha (TNF-α), is an established therapy for refractory sarcoidosis. However, data on its long-term efficacy and safety profile remain limited. 

Objectives: We aimed to evaluate sustained clinical response and adverse events associated with prolonged infliximab therapy.

Materials and Methods: We performed a retrospective analysis of patients with biopsy-proven sarcoidosis treated with infliximab for ≥24 months due to failure of conventional therapies. A total of 97 patients were included. Clinical outcomes, pulmonary function tests, imaging findings, and patient-reported symptoms were assessed before and after long-term therapy. Changes in corticosteroid and immunosuppressive use, as well as adverse events, were recorded.

Results: Ninety-seven patients met inclusion criteria. Infliximab dosing ranged from 5–10 mg/kg administered every 4–8 weeks. Median treatment duration was 46 months ranging from 24 to 132 months. Sustained clinical improvement was observed in 91% of patients overall, including 94% (68/72) with pulmonary involvement, 93% (14/15) with cardiac involvement, and 94% (16/17) with cutaneous involvement. Among patients with pulmonary involvement, there were significant improvements in forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁), including both absolute values and percent predicted (p < 0.05). A steroid-sparing effect was observed, with 40% of patients completely discontinuing corticosteroids. Reduction in overall immunosuppressive burden was noted across organ systems. Long-term infliximab therapy was generally well tolerated. One patient discontinued therapy due to development of palmoplantar pustulosis.

Conclusions: Long-term infliximab therapy provides sustained clinical benefit, improves pulmonary function, and reduces corticosteroid dependence in refractory pulmonary and extra-pulmonary sarcoidosis. The therapy demonstrates a favorable safety profile over extended use, supporting its role as a long-term treatment option.