Abstract

Background: Results of uncontrolled studies suggested infliximab efficacy against systemic necrotizing vasculitides (SNV) refractory to conventional therapy. However, its safety and ability to induce and maintain remission over the long term remain unknown. Objectives: To report our experience using infliximab to treat refractory SNV, focusing on the patients’ longer-term outcomes.

Methods: The medical charts of patients given adjunctive infliximab for refractory SNV ≥2 years before this evaluation were reviewed retrospectively.

Results: The 15 patients (median age: 46 [range 20–69] years; median follow-up: 35 [24–41] months) included 10 with Wegener’s granulomatosis, 1 microscopic polyangiitis, 3 rheumatoid arthritis-associated and 1 cryoglobulinemia-related vasculitides. Median time on infliximab was 8 [2–31] months; 2 patients are still being treated. By day 45, 11 patients had entered remission (BVAS=0) and 4 others had responded (BVAS decrease ≥50%). Five patients achieved sustained remissions (≥6 months, corticosteroids ≤7.5 mg/day). Thirteen stopped infliximab because of loss of efficacy (n=4), remission (n=6), or non-compliance, chest tightness or side effect (1 each). Ten patients relapsed (median interval: 13 months), 3 while still receiving infliximab; 2 were successfully retreated with infliximab.

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