TY - JOUR
T1 - Infliximab for the treatment of CNS sarcoidosis
T2 - A multi-institutional series
AU - Gelfand, Jeffrey M.
AU - Bradshaw, Michael J.
AU - Stern, Barney J.
AU - Clifford, David B.
AU - Wang, Yunxia
AU - Cho, Tracey A.
AU - Koth, Laura L.
AU - Hauser, Stephen L.
AU - Dierkhising, Jason
AU - Vu, Ngoc Hanh
AU - Sriram, Subramaniam
AU - Moses, Harold
AU - Bagnato, Francesca
AU - Kaufmann, Jeffrey A.
AU - Ammah, Deidre J.
AU - Yohannes, Tsion H.
AU - Hamblin, Mark J.
AU - Venna, Nagagopal
AU - Green, Ari J.
AU - Pawate, Siddharama
N1 - Publisher Copyright:
© 2017 American Academy of Neurology.
PY - 2017
Y1 - 2017
N2 - Objective: To describe clinical and imaging responses in neurosarcoidosis to infliximab, a monoclonal antibody against tumor necrosis factor-a. Methods: Investigators at 6 US centers retrospectively identified patients with CNS sarcoidosis treated with infliximab, including only patients with definite or probable neurosarcoidosis following rigorous exclusion of other causes. Results: Of 66 patients with CNS sarcoidosis (27 definite, 39 probable) treated with infliximab for a median of 1.5 years, the mean age was 47.5 years at infliximab initiation (SD 11.7, range 24-71 years); 56.1% were female; 62.1% were white, 37.0% African American, and 3% Hispanic. Sarcoidosis was isolated to the CNS in 19.7%. Using infliximab doses ranging from 3 to 7 mg/kg every 4-8 weeks, MRI evidence of a favorable treatment response was observed in 82.1% of patients with imaging follow-up (n = 56), with complete remission of active disease in 51.8% and partial MRI improvement in 30.1%; MRI worsened in 1 patient (1.8%). There was clinical improvement in 77.3% of patients, with complete neurologic recovery in 28.8%, partial improvement in 48.5%, clinical stability in 18.2%, worsening in 3%, and 1 lost to follow-up. In 16 patients in remission when infliximab was discontinued, the disease recurred in 9 (56%), typically in the same neuroanatomic location. Conclusions: Most patients with CNS sarcoidosis treated with infliximab exhibit favorable imaging and clinical treatment responses, including some previously refractory to other immunosuppressive treatments.
AB - Objective: To describe clinical and imaging responses in neurosarcoidosis to infliximab, a monoclonal antibody against tumor necrosis factor-a. Methods: Investigators at 6 US centers retrospectively identified patients with CNS sarcoidosis treated with infliximab, including only patients with definite or probable neurosarcoidosis following rigorous exclusion of other causes. Results: Of 66 patients with CNS sarcoidosis (27 definite, 39 probable) treated with infliximab for a median of 1.5 years, the mean age was 47.5 years at infliximab initiation (SD 11.7, range 24-71 years); 56.1% were female; 62.1% were white, 37.0% African American, and 3% Hispanic. Sarcoidosis was isolated to the CNS in 19.7%. Using infliximab doses ranging from 3 to 7 mg/kg every 4-8 weeks, MRI evidence of a favorable treatment response was observed in 82.1% of patients with imaging follow-up (n = 56), with complete remission of active disease in 51.8% and partial MRI improvement in 30.1%; MRI worsened in 1 patient (1.8%). There was clinical improvement in 77.3% of patients, with complete neurologic recovery in 28.8%, partial improvement in 48.5%, clinical stability in 18.2%, worsening in 3%, and 1 lost to follow-up. In 16 patients in remission when infliximab was discontinued, the disease recurred in 9 (56%), typically in the same neuroanatomic location. Conclusions: Most patients with CNS sarcoidosis treated with infliximab exhibit favorable imaging and clinical treatment responses, including some previously refractory to other immunosuppressive treatments.
UR - http://www.scopus.com/inward/record.url?scp=85037711553&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000004644
DO - 10.1212/WNL.0000000000004644
M3 - Article
C2 - 29030454
AN - SCOPUS:85037711553
SN - 0028-3878
VL - 89
SP - 2092
EP - 2100
JO - Neurology
JF - Neurology
IS - 20
ER -