Cardiac sarcoidosis (CS) is frequently difficult to treat. Infliximab (IFX) is useful
for extracardiac sarcoidosis, but its use in CS has been limited due to concerns about
cardiotoxicity and an FDA blackbox warning about use in heart failure. We reviewed
36 consecutive patients treated with infliximab for CS refractory to standard therapies.
IFX was initiated for patients with refractory dysrhythmias, moderate to severe cardiomyopathy,
and evidence of persistent F-18 fluorodeoxyglucose uptake on positron emission tomography
scan, despite standard therapies. We compared the prednisone dose, ejection fraction
(EF), and dysrhythmias before and after IFX therapy. The prednisone-equivalent steroid
dose decreased from a median of 20 mg at initiation of infliximab to 7.5 at 6 months
and 5 mg at 12 months postinitiation of infliximab (p <0.001). In the 25 patients
with serial EF measurements, no statistically significant difference was detected
in EF (41% at baseline, 42% at 6 months). Of the 16 patients with serial dysrhythmia
data, there was a trend toward reduction of percent of patients with ventricular tachycardia
(VT), from 32% at baseline, to 22% at 6 months and 19% at 12 months (p = 0.07). Adverse
events were common, occurring in 6 of 36 patients, with 3 of 36 patients stopping
infliximab for a prolonged period. In responder analysis, 24 patients improved in
at least 1 of 3 outcome categories. In conclusion, infliximab may be useful for refractory
cardiac sarcoidosis.
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Article info
Publication history
Published online: August 23, 2019
Received in revised form:
July 29,
2019
Received:
April 29,
2019
Footnotes
Financial disclosure: None of the authors have any financial interests to disclose.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
