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Infliximab for the treatment of CNS sarcoidosis: A multi-institutional series
Jeffrey M Gelfand1, Michael J Bradshaw1, Barney J Stern1
1From the Department of Neurology (J.M.G., S.L.H., J.D., A.J.G.), Division of Pulmonary and Critical Care, Department of Medicine (L.L.K.), and Department of Ophthalmology (A.J.G.), University of California San Francisco; Department of Neurology (M.J.B., N.V., S.S., H.M., F.B., S.P.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (B.J.S., J.A.K., D.J.A.), University of Maryland Medical Center, Baltimore; Departments of Neurology and Medicine (D.B.C., T.H.Y.), Washington University in St. Louis, MO; Department of Neurology (Y.W., M.J.H.), University of Kansas Medical Center, Kansas City; and Department of Neurology (T.A.C., N.V.), Massachusetts General Hospital, Boston.
Objective:
To describe clinical and imaging responses in neurosarcoidosis to infliximab, a monoclonal antibody against tumor necrosis factor-α.
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.
Classification Of Evidence:
This study provides Class IV evidence that for patients with CNS sarcoidosis infliximab is associated with favorable imaging and clinical responses.