(from "Abstract Band", ausgewählte Abstracts, American College of Rheumatology (ACR) 2002 Annual Meeting, 25.-29. Oktober 2002, New Orleans
Essex Pharma GmbH.)
Peter Lamprecht (1), Olga Arbach (1), Jan Vosswinkel (1), Thomas Lilienthal (1), Bernhard Noelle (2), Martin Heller (2), Angela Gause (1), Wolfgang L Gross (1)
1= Universitiy of Luebeck, Luebeck, Germany; 2=University of Kiel, Kiel, Germany
Purpose
To report the results of the follow-up of 6 patients with WG refractory to standard oral cyclophosphamide and corticosteroids (Fauci's scheme) with progressive, imminent visual loss, pulmonary and renal involvement, respectively. Addition of the humanized chimeric monoclonal anti-TNFalpha antibody infliximab led to the induction of remission. we report on the follow-up of 6 patients in order to determine how long remissions could be successfully maintained and what side-effects occurred?
Patients & Methods
Patients received 3mg/kg and - because of the impression of higher effectiveness - 5 mg/kg infliximab, respectively, in addition to the standard therapy with cyclophosphamide and corticosteroids. Intervals between the first two infliximab infusions were two weeks, thereafter 4 weeks.
Results
Remission was induced in 5 patients after 4 to 6 infliximab infusions. Remission has been maintained in 4 patients for 16-26 months. After 12 months a pulmonary relapse occurred in one patient, who took azathioprine for the maintenance of remission. Infliximab was stopped in another patient because of a suspected infection. Subsequently, remission could not be induced in this patient with other previously advocated salvage therapies. In the light of high cumulative cyclophosphamide doses (100g/275g) and cyclophosphamide induced hemorrhagic cystitis, infliximab was added to azathioprine in the two patients with a pulmonary relapse and protrusio bulbi with imminent visual loss, respectively. Remissions were successfully induced in both patients. Respiratory infections were encountered in 2 patients. A carcinoid of the bronchus was diagnosed in one patient after 12 months in remission.
Conclusion
Addition of infliximab proved to be highly effective in inducing remissions in therapy refractory WG. Remissions lasting 16-26 months have been observed so far. Relapses can be successfully treated again with infliximab. However, infections mean a potential hazard limiting - in our opinion - the use of infliximab to patients with refractory WG or other special therapy related situations. In this scenario, infliximab means a new and effective therapeutic option for a patient group with a previously poor prognosis.
Arthritis Rheum (2002) Vol. 46 No. 9 (Suppl.)