Infliximab efficacy and safety against refractory systemic necrotising vasculitides: long-term follow-up of 15 patients

Josselin, L.; Mahr, Alfred; Cohen, Pascal; Pagnoux, Christian; Guaydier-Souquières, G; Hayem, Gilles; Job-Deslandre, C; Liferman, François; Pourrat, Jacques; Guillevin, L

doi:10.1136/ard.2007.083584

Cited by 83 publications

(31 citation statements)

References 13 publications

(12 reference statements)

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“…No study to date has adequately assessed the capacity of TNF blockade to substitute for standard therapies in AAV. A steroid-sparing effect of infliximab has been reported in patients with persistently active AAV [10,23] and in this study the older patients treated with infliximab and a reduced dose of prednisolone achieved clinical remission at the same rate as those younger patients treated with infliximab and a standard dose of prednisolone. Conceivably, infliximab might allow reduction of cumulative corticosteroid and/or cyclophosphamide doses in patients with newly presenting or relapsing AAV.…”

Section: Discussionsupporting

confidence: 55%

Addition of Infliximab to Standard Therapy for ANCA-Associated Vasculitis

et al. 2010

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Background: Tumour necrosis factor-α (TNF) is implicated in the pathogenesis of anti-neutrophil cytoplasm antibody-associated vasculitis (AAV). Current immunosuppressive therapy is associated with considerable morbidity and mortality. Anti-TNF antibody therapy (infliximab) may help control AAV by providing more targeted immunosuppression and allow reductions in the use of corticosteroids and cyclophosphamide, thereby reducing the burden of immunosuppression with its associated morbidity and mortality. Methods: 33 patients with active AAV participated in this cohort study. Patients were treated with standard therapy (corticosteroids and cyclophosphamide with additional plasma exchange in the case of life- or organ-threatening disease) or standard therapy + infliximab at weeks 0, 2, 6 and 10. The primary outcome measure was time to remission. Other outcome measures were adverse events, cumulative damage scores and relapse, as well as biomarkers for circulating activated and regulatory T cells. Follow-up was for 12 months. Results: 17 patients received standard therapy alone; 16 patients received additional infliximab. The addition of infliximab to standard therapy did not influence remission rates, adverse events, damage index scores, relapse rates or biomarker levels in this cohort study. Conclusion: The addition of infliximab to standard therapy did not confer clinical benefit for patients with active AAV.

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Section: Discussionsupporting

confidence: 55%

Addition of Infliximab to Standard Therapy for ANCA-Associated Vasculitis

et al. 2010

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“…Based on the beneficial effects of TNF blockade in other chronic inflammatory disorders and the fact that several lines of evidence implicate TNF in the pathogenesis of AAV in humans and animal models of the disease, several small pilot studies evaluated the therapeutic potential of infliximab revealing promising results. However, data derived from subsequent studies were conflicting and could not corroborate any additional benefit from the use of infliximab in patients with AAV (Booth et al 2004;Josselin et al 2008;Morgan et al 2010). It should be noted that there is no RCT for infliximab in AAV.…”

Section: Other Treatmentsmentioning

confidence: 93%

“…Deoxyspergualin (0.5 mg/Kg/day subcutaneously in 6 cycles of 21 days with 7-day intervals), an antiproliferative agent licensed in Japan for acute renal transplant rejection, showed promise in phase II study (Flossmann et al 2009). Infliximab was beneficial in refractory disease in observational studies (Josselin et al 2008) but when added to standard induction treatment did not make any difference ).…”

Section: Refractory Diseasementioning

confidence: 99%

Treatment of ANCA – Associated Vasculitis

Katsiari¹,

Sakkas²

2011

Advances in the Diagnosis and Treatment of Vasculitis

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“…In an open study, Bartolucci et al demonstrated that infliximab used in 10 patients (7 with Wegener's granulomatosis) with severe vasculitides refractory to corticosteroids and immunosuppressive agents could also have led to complete or partial remission in all patients [79]. Moreover, infliximab may have a suspensive and transient beneficial effect because of relapses evidenced after discontinuation [80]. Etanercept has also been evaluated in association with conventional therapy to reduce the relapse rate versus placebo in the WGET trial.…”

Section: Systemic Necrotizing Vasculitidesmentioning

confidence: 99%

Biologics and the Cardiovascular System: A Double-Edged Sword

Roubille

Martel‐Pelletier²,

Tardif³

et al. 2013

AIAAMC

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Abstract:Patients with chronic inflammatory diseases such as rheumatoid arthritis have a higher risk of cardiovascular diseases and related mortality compared to the general population. This risk is first due to classical cardiovascular risk factors but also due to systemic inflammation which is independently involved, causing accelerated atherosclerosis, myocardial infarction, cerebrovascular disease and heart failure (HF). Pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1 and IL-6 could be major actors on this pathophysiology. Biologics are effective specific treatments in the management of inflammatory rheumatic and systemic diseases. In this review, beneficial and deleterious effects on the heart and vessels of the biologics used in the management of inflammatory arthritis and vasculitides will be discussed, focusing on TNF-alpha, IL-6 and IL-1 blockades, and anti-CD20. Noninflammatory cardiac conditions, such as heart failure, myocardial infarction, and cardiovascular conditions such as atherosclerosis, as well as inflammatory diseases including vasculitides will be discussed.

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Infliximab efficacy and safety against refractory systemic necrotising vasculitides: long-term follow-up of 15 patients

Abstract: These observations highlight infliximab as a potentially useful and safe salvage treatment for patients with refractory SNV.

Cited by 83 publications

References 13 publications

Addition of Infliximab to Standard Therapy for ANCA-Associated Vasculitis

Addition of Infliximab to Standard Therapy for ANCA-Associated Vasculitis

Treatment of ANCA – Associated Vasculitis

Biologics and the Cardiovascular System: A Double-Edged Sword

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