C-reactive protein predicts response to infliximab in patients with chronic sarcoidosis

Sarcoidosis Vasc Diffuse Lung Dis. 2010 Jul;27(1):49-56.

Abstract

Background: This study assessed the value of C-reactive protein as a predictor of disease severity and response to infliximab therapy in patients with chronic pulmonary sarcoidosis.

Design: Sera were collected through week 52 from 138 patients with chronic pulmonary sarcoidosis who received placebo or infliximab in a randomized, double-blind, placebo-controlled study. We evaluated the response to therapy by baseline CRP using a dichotomous cutpoint (0.8 mg/dL) for the change from baseline in percent-predicted forced vital capacity (FVC), Saint George's Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), Borg's CR10 dyspnea score, and Physician Organ Assessment (POA).

Results: CRP was elevated in 36% of patients at baseline, and was significantly reduced by infliximab by week 2. Among patients with elevated baseline CRP, infliximab-treated patients improved significantly compared with placebo-treated patients in percent-predicted FVC (+2.5 versus -2.6%), 6MWD (+8.0 versus -34.1), Borg's CR10 dyspnea score (pre-6MWD -0.8 versus +0.9, post-6MWD -1.1 versus +0.8), and POA (-3.1 versus -0.3). Patients with lower CRP levels at baseline did not show significant differences between the placebo and infliximab groups in most endpoints evaluated.

Conclusions: In chronic sarcoidosis patients, elevated CRP appears to identify a subset with more severe disease who may respond better to treatment with infliximab.

Trial registration: ClinicalTrials.gov NCT00073437.

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use*
  • Antibodies, Monoclonal / therapeutic use*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Chronic Disease
  • Clinical Trials, Phase II as Topic
  • Double-Blind Method
  • Dyspnea / drug therapy
  • Dyspnea / immunology
  • Exercise Test
  • Exercise Tolerance
  • Female
  • Humans
  • Infliximab
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Sarcoidosis, Pulmonary / drug therapy*
  • Sarcoidosis, Pulmonary / immunology
  • Sarcoidosis, Pulmonary / physiopathology
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • United States
  • Vital Capacity
  • Walking

Substances

  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Biomarkers
  • C-Reactive Protein
  • Infliximab

Associated data

  • ClinicalTrials.gov/NCT00073437