Effects of Infliximab (Remicade) on Fat Free Mass in Patients With Moderate to Severe COPD Suffering From Cachexia

Inclusion Criteria: 1. COPD acording GOLD with FEV1/FVC ratio < 70%, and post-bronchodilator FEV1 > 20% but < 80% of predicted and an FEV1 of >500ml. 2. Fat Free Mass Index : <17.5 kg/m2 in males, <15 kg/m2 in females. 3. Symptomatic (eg, chronic cough, sputum production, shortness of breath) for at least 2 months 4. >= 40 years of age and ≤ 80 years of age 5. History of >=10 pack years of smoking 6. Men and women of childbearing potential must use adequate birth control measures at least one month prior to screening and for the duration of the study and should continue such precautions for 6 months after receiving the last infusion. 7. Ability to adhere to the study visit schedule and other protocol requirements 8. Provide signed, written informed consent prior to participation in the study 9. Be adequately immunized against S. pneumoniae. Patients enrolling in the study in autumn and winter months should be immunized against influenza 10. The screening laboratory test results must meet the following criteria: Hemoglobin >= 8.5 g/dL WBC >= 3.5 x 109/L Neutrophils >= 1.5 x 109/L Platelets >= 100 x 109/L SGOT (AST) and alkaline phosphatase levels must be within 3 times the upper limit of normal range for the laboratory conducting the test. TSH within the normal range of 0.3 to 5 mIU/L. 11. Are considered eligible according to the tuberculosis (TB) eligibility assessment, screening, and early detection of reactivation rules Exclusion Criteria: > 11% increase in FEV1 as % of predicted after a fixed dose of bronchodilator (200 µg inhaled salbutamol) >12% variation between screening and baseline FEV1 assessments FEV1 < 500 ml Patients with asthma as main component of their obstructive airways disease Moderate or severe exacerbation of COPD within previous 2 months History or clinical signs of severe cor pulmonale, or pulmonary hypertension, severe right or left sided cardiac failure, serious arrhythmias, myocardial infarction or cardiac interventions within 6 months of screening. Exclusion criteria on echocardiogram: Exclude patients with right-sided heart defects, as defined by any 1 of the following 3 echocardiography criteria: Right ventricular size increased, with an inlet diameter of >5cm Moderate-to-severe tricuspid valve regurgitation Right ventricular (RV)-right atrial (RA) pressure drop of >50 mmHg Exclusion of patients with left ventricular ejection fraction (LV EF) of <40%, as measured on echocardiography. Exclusion criteria on electrocardiogram: Exclude patients with the following arrhythmias identified on electrocardiography (ECG): Fast atrial fibrillation at ventricular rate of >90/min Atrial-ventricular conduction delay of grade 2 or higher : excludes 2nd and 3rd degree heart block. Left bundle branch block, with QRS complex >120msec. Ventricular arrhythmias: ventricular tachycardia and trigeminy. 7. Chronic respiratory failure (PaO2 < 7.3kPa with or without hypercapnia) and patients requiring long term oxygen therapy. 8. Participation in the acute phase of a pulmonary rehabilitation program within 4 weeks prior to screening or planned participation in pulmonary rehabilitation during the study 9. Stopping smoking or attending a smoking cessation class within 6 weeks of enrollment. 10. Known a1 antitrypsin deficiency 11. Serious acute infections (eg, hepatitis, pneumonia or pyelonephritis) in the previous 3 months 12. Major surgery in the previous 3 months 13. Women who are pregnant, nursing, or planning pregnancy within one year after screening (i.e., approximately 6 months following last infusion) 14. Use of any investigational drug within 1 month prior to screening or within 5 half?lives of the investigational agent, whichever is longer 15. Treatment with any other therapeutic agent targeted at reducing TNFa (e.g. pentoxifylline, thalidomide, etanercept, etc.) within 3 months of screening. Treatment with immunosuppressive or cytotoxic therapy. 16. Previous administration of infliximab 17. Known allergy to murine products 18. Are considered ineligible according to the TB eligibility assessment, screening, and early detection of reactivation rules defined in Section 4.3. 19. Have or have had an opportunistic infection (eg, herpes zoster [shingles], cytomegalovirus, Pneumocystis carinii, aspergillosis, histoplasmosis, or mycobacteria other than TB) within 6 months prior to screening. 20. Have a chest radiograph at screening that shows evidence of malignancy, infection, or any abnormalities suggestive of TB 21. Have had an opportunistic infection (e.g. herpes zoster [shingles], cytomegalovirus, Pneumocystis carinii, aspergillosis, histoplasmosis, or mycobacteria other than TB) within 6 months of screening. 22. Documented HIV infection. 23. Positive serology for active hepatitis B or C based on all subjects being tested at screening. A positive result will indicate referral to a consultant Hepatologist for further investigation and support. 24. Have current signs or symptoms of severe, progressive or uncontrolled renal, hepatic, hematological, gastrointestinal, endocrine, cardiac, neurologic, or cerebral disease (including demyelinating diseases such as multiple sclerosis) 25. Presence of a transplanted organ (with the exception of a corneal transplant > 3 months prior to screening) 26. Malignancy within the past 5 years (except for squamous or basal cell carcinoma of the skin that has been treated with no evidence of recurrence) 27. History of lymphoproliferative disease including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy of unusual size or location (such as nodes in the posterior triangle of the neck, infra?clavicular, epitrochlear, or periaortic areas), or splenomegaly 28. Known recent substance abuse (drug or alcohol) 29. Poor tolerability of venipuncture or lack of adequate venous access for required blood sampling during the study period 30. Known atypical mycobacterium infection