The Safety and Efficacy of Infliximab in Moderate to Severe Chronic Obstructive Pulmonary Disease

TLDR

COPD is a progressive, smoking‑related inflammatory lung disease characterized by overexpression of tumor necrosis factor‑α, which is implicated in its pathogenesis. The study aimed to assess whether infliximab provides clinical benefit and an acceptable safety profile in moderate to severe COPD patients. Patients received 3 mg/kg or 5 mg/kg infliximab or placebo every 2–6 weeks in a multicenter, randomized, double‑blind, placebo‑controlled trial, with outcomes evaluated up to week 44. Infliximab showed no clinical benefit on the primary or secondary outcomes and was associated with higher rates of malignancy, pneumonia, and treatment discontinuation, though no opportunistic infections or infection‑related deaths occurred.

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive, smoking-related, inflammatory lung disease in which tumor necrosis factor-alpha is overexpressed and has been suggested to play a pathogenic role.To determine if infliximab, an anti-TNF-alpha antibody, results in clinical benefit and has an acceptable safety profile in patients with moderate to severe COPD.In a multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-finding study, subjects with moderate to severe COPD received infliximab (3 mg/kg [n = 78] or 5 mg/kg [n = 79]) or placebo (n = 77) at Weeks 0, 2, 6, 12, 18, and 24. Efficacy, health status, and safety were assessed through Week 44.Infliximab was generally well tolerated, but showed no treatment benefit as measured by the primary endpoint, Chronic Respiratory Questionnaire total score. Similarly, there was no change in secondary measures, including prebronchodilator FEV(1), 6-min walk distance, SF-36 physical score, transition dyspnea index, or moderate-to-severe COPD exacerbations. Post hoc analysis revealed that subjects who were younger or cachectic showed improvement in the 6-min walk distance. Malignancies were diagnosed during the study in 9 of 157 infliximab-treated subjects versus 1 of 77 placebo-treated subjects. No opportunistic infections were observed, and there were no differences in the occurrence of antibiotic-requiring infections, although the incidence of pneumonia was higher in infliximab-treated subjects. No infection-related mortality was observed. Higher proportions of infliximab-treated subjects discontinued the study agent due to adverse events (20-27%) than did placebo-treated subjects (9%).Subjects with moderate to severe COPD did not benefit from treatment with infliximab. Although not statistically significant, more cases of cancer and pneumonia were observed in the infliximab-treated subjects. The impact of infliximab on malignancy risk in patients with COPD needs to be further elucidated.