European Respiratory Society Annual Congress 2013 Abstract Number: 1219 Publication Number: 3063 Abstract Group: 1.5. Diffuse Parenchymal Lung Disease Keyword 1: Sarcoidosis Keyword 2: Biomarkers Keyword 3: Treatments Title: Relapse after discontinuation of infliximab in sarcoidosis patients can be predicted by PET-scan and sIL-2R Mrs. Adriane D.M. 14201 Vorselaars
[email protected] MD 1, Mrs. Anouk 14202 Verwoerd
[email protected] 1,2, Dr. Coline H.M. 14203 Van Moorsel
[email protected] 1,3, Dr. Ruth G.M. 14205 Keijsers
[email protected] MD 4, Dr. Ger T. 14211 Rijkers
[email protected] 2,5 and Prof. Jan C. 14212 Grutters
[email protected] MD 1,3. 1 Centre of Interstitial Lung Diseases, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Utrecht, Netherlands ; 2 Science Department, Roosevelt Academy University College, Middelburg, Netherlands ; 3 Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, Netherlands ; 4 Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, Utrecht, Netherlands and 5 Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, Utrecht, Netherlands . Body: BACKGROUND: The biological anti-TNF drug infliximab is used as third-line therapy for severe sarcoidosis. Long-term outcome and relapse rate after discontinuation of infliximab treatment in sarcoidosis patients are unknown. OBJECTIVES: To assess the clinical relapse rate after discontinuation of infliximab therapy in sarcoidosis patients and predict relapse by analysis of disease activity markers soluble IL-2 receptor (sIL-2R) and maximum standardized uptake value (SUVmax) of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET). METHODS: In this retrospective cohort study, relapse was defined as the return of symptoms and signs of disease activity with need for retreatment. The proportion of relapse was analyzed using Kaplan-Meier and predicting factors were studied with Cox regression analysis. RESULTS: 47 sarcoidosis patients who started infliximab therapy could be included in risk analysis. Mean treatment duration was 8.5 months. After treatment discontinuation, 29 patients (62%) relapsed after a mean of 7.8 months. Both mediastinal SUVmax ≥ 6.0 on 18F-FDG PET (HR 3.77, P<.001) and serum sIL-2R ≥ 4,000 pg/mL (HR 2.24, P =.033) at start of therapy were significant predictors of relapse. In multivariate analysis, a mediastinal SUVmax ≥ 6.0 at initiation was an independent predictor of relapse (HR 4.33, P<.001). CONCLUSIONS: The majority of patients that discontinued infliximab therapy had relapse of disease and required retreatment. High serum sIL-2R level and high SUVmax on 18F-FDG-PET at initiation of therapy are significant predictors of relapse. Therefore, close monitoring of patients in this category is suggested when they discontinue infliximab treatment.
