Medically refractory neurosarcoidosis treated with infliximab

Pereira, Jennifer A.; Anderson, N. E.; McAuley, David; Bergin, Peter; Kilfoyle, Dean; Fink, John

doi:10.1111/j.1445-5994.2011.02457.x

Cited by 33 publications

(22 citation statements)

References 15 publications

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“…This latter effect may account for its efficacy in sarcoidosis as an antimacrophage agent and differentiates infliximab from other anti-TNF agents. A favorable response to infliximab treatment has been reported in a number of isolated clinical reports and small case series that have primarily involved single organ refractory sarcoidosis [6]. The efficacy of anti-TNF therapy in multisystem refractory disease is less clear, although a few isolated reports suggest it may be beneficial [7,8].…”

Section: Discussionmentioning

confidence: 97%

Refractory multisystem sarcoidosis responding to infliximab therapy

et al. 2012

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Chronic progressive multisystem granulomatous disease is seen in 10-30% of patients with sarcoidosis and can result in end organ damage. Corticosteroids are the mainstay of treatment with the addition of cytotoxic agents in severe cases. Some patients are refractory to such treatment and, therefore, management is a challenge. There is currently limited evidence for biological agents such as infliximab, a monoclonal anti-tumor necrosis factor-α antibody in the treatment of multisystem sarcoidosis. We report outcomes of three patients with extensive multisystem sarcoidosis refractory to conventional treatment and treated at our center. Clinical assessment and radiographic imaging were used to assess the response to infliximab treatment. Infliximab therapy induced clinical remission in all three patients, and this clinical response correlated with radiographic evidence of the resolution of granulomatous disease. Serum ACE level was reduced in all cases, and daily steroid dosage was reduced. We propose that infliximab can be an effective treatment in patients with multisystem complex sarcoidosis refractory to conventional drug therapy and can result in sustained clinical remission. Our experience supports the urgent need for randomized controlled clinical trials of anti-TNF therapy in refractory systemic sarcoidosis.

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Section: Discussionmentioning

confidence: 97%

Refractory multisystem sarcoidosis responding to infliximab therapy

et al. 2012

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“…TNF-a is a key mediator in the formation of sarcoid granulomas and elevated TNF-a levels is associated with a persistent clinical course and granuloma formation. There are case reports and case series to show its efficacy for refractory neurosarcoidosis [88][89][90]. It is important to be aware that various neurological deficits are reported during treatment with TNF-a blocker, including CNS or PNS demyelination [91].…”

Section: Initial Evaluationsmentioning

confidence: 98%

Neurosarcoidosis: Clinical manifestations, diagnosis and treatment

2012

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“…Sarcoidosis is probably a CD4+ T lymphocyte-mediated disease, with the release of TNF-α being important in the pathogenesis of granuloma formation 11. In 2011, Pereira et al 12 summarised 23 cases of refractory sarcoidosis that subsequently responded to treatment with infliximab. Most had previously received corticosteroids and an additional immunosuppressive agent.…”

Section: Discussionmentioning

confidence: 99%

Multiple cerebral infarcts: a rare complication of neurosarcoidosis

2019

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A 52-year-old man experienced a relapse of neurosarcoidosis, characterised by obstructive hydrocephalus and multiple posterior circulation infarcts. He was taking methotrexate, but his prednisolone was being weaned because of adverse effects. Stroke is rare in neurosarcoidosis and typically relates to granulomatous inflammation with a predilection for the perforator arteries. Sarcoidosis generally responds well to corticosteroids; however, patients with leptomeningeal involvement usually require additional immunosuppression as relapses can occur on weaning of corticosteroids. It is worth considering tumour necrosis factor-α antagonists for cases that progress despite first-line therapy.

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Medically refractory neurosarcoidosis treated with infliximab

Cited by 33 publications

References 15 publications

Refractory multisystem sarcoidosis responding to infliximab therapy

Refractory multisystem sarcoidosis responding to infliximab therapy

Neurosarcoidosis: Clinical manifestations, diagnosis and treatment

Multiple cerebral infarcts: a rare complication of neurosarcoidosis

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