Treatment of refractory neurosarcoidosis with Infliximab

Santos, Ernestina; Shaunak, Sandip; Renowden, Shelley; Scolding, Neil

doi:10.1136/jnnp.2008.149989

Cited by 67 publications

(29 citation statements)

References 21 publications

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“…Several case reports suggest that infliximab, a tumor necrosis-a inhibitor, is useful in cases of spinal cord sarcoidosis refractory to more conservative management (Pritchard and Nadarajah, 2004;Sollberger et al, 2004;Saleh et al, 2006;Santos et al, 2010). Given the extreme rarity of spinal cord sarcoidosis, its overall dismal prognosis with traditional management, and the impressive results reported with infliximab, clinicians should be aware of its potential application to this often disabling disease and consider early treatment.…”

Section: Sarcoidosismentioning

confidence: 99%

Acute inflammatory myelopathies

Cree

2014

Handbook of Clinical Neurology

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Section: Sarcoidosismentioning

confidence: 99%

Acute inflammatory myelopathies

Cree

2014

Handbook of Clinical Neurology

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“…Infliximab is a chimeric monoclonal antibody that neutralizes the biological activity of TNF-alpha by binding to its soluble and transmembrane forms and inhibiting receptor binding 44 . Evidence for its use came from the finding of elevated TNF-alpha levels in lymph nodes and BAL of patients with sarcoidosis 39 and by the demonstration that it is a crucial cytokine in the establishment and maintenance of inflammation in several autoimmune disorders 44 .…”

Section: Anti-tnf Agentsmentioning

confidence: 99%

“…Evidence for its use came from the finding of elevated TNF-alpha levels in lymph nodes and BAL of patients with sarcoidosis 39 and by the demonstration that it is a crucial cytokine in the establishment and maintenance of inflammation in several autoimmune disorders 44 . There are 23 reports on the use of infliximab for refractory NS, sometimes in association with other immunosuppressive agents, such as CFA or MMF 36,41,45,46 .…”

Section: Anti-tnf Agentsmentioning

confidence: 99%

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Neurosarcoidosis: guidance for the general neurologist

Dutra

Braga‐Neto

Oliveira

et al. 2012

Arq. Neuro-Psiquiatr.

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Sarcoidosis is an inflammatory multisystem disorder of unknown etiology with a worldwide distribution that can affect lungs, lymphatic system, skin, liver, eyes, and nervous system 1 . We owe the first recorded and illustrated description of sarcoidosis to Jonathan Hutchinson in 1878, when he reported a patient with a dermatologic disease, which comprised purplish, symmetric, and non-tender skin plaques, initially considered a manifestation of gout 2 . The term sarcoidosis comes from histological studies performed by Cesar Boeck, in 1899, who described pathological findings of skin lesions that resembled those of sarcoma, which he called 'sarkoid ' or 'sarcoma-like' 3 . Involvement of the nervous system was first recognized, in 1905, by Winkler, and, in 1909, Heerfordt described three patients in the context of facial nerve palsies, uveitis, parotid enlargement, and fever 1,3 . Neurosarcoidosis (NS) may involve any part of the nervous system with acute and chronic courses 1,4 . Cranial nerves, hypothalamus, and pituitary gland are the most commonly regions involved, but meninges, parenchyma, brainstem, and spinal cord may also be affected 4 . Clinical differentiation from other neurological diseases may be difficult when an isolated involvement of the nervous system is present 3,4 . In this review, we highlighted its clinical forms, pathogenesis, and treatment guidelines for NS, as guidance for general neurologists. neUROLOGiCaL ManiFesTaTiOns OF saRCOidOsisNeurologic manifestations are found in 5 to 20% of cases and symptoms may be mild or even severe, requiring a more aggressive intervention. About one-half of patients with NS can develop neurologic manifestations before systemic sarcoidosis is evident absTRaCT Neurosarcoidosis (NS) more commonly occurs in the setting of systemic disease. The diagnosis is based on a clinical history suggestive of NS, presence of noncaseating granulomas, and supportive evidence of sarcoid pathology, laboratory, and imaging studies. NS could involve any part of the nervous system and often demands high doses of steroids for symptom control. It presents low response to isolated steroids administration and frequently requires immunosuppressive agents. In NS, lymphocytes are polarized toward an excessive Th1 response, leading to overproduction of TNF-alpha and INF-gama, as well as lL-2 and IL-15. Infliximab, a chimeric monoclonal antibody that neutralizes the biological activity of TNF-alpha, is a new option in the NS treatment. We revised pathophysiology, clinical manifestations, diagnostic work up, and treatment of NS as guidance for the general neurologist.Key words: sarcoidosis, neurosarcoidosis, methotrexate, azathioprine, cyclophosphamide, infliximab. ResUMOA neurosarcoidose (NS) ocorre frequentemente no contexto de doença sistêmica. O diagnóstico é baseado na história clínica sugestiva de NS, presença de granulomas não-caseosos e achados anatomopatológicos, laboratoriais e radiológicos de sarcoidose. A NS causa manifestações neurológicas variadas, que apresentam, em ge...

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“…Nevertheless, there is a large and growing support for its efficacy, though lacking any confirmatory prospective study. Its use may be considered in patients refractory to other medical treatment (Pereira et al 2011, Santos et al 2010, Aksamit 2008. Likewise, thalidomide also has properties that involve tumor necrosis factor-α blockade.…”

Section: Treatmentmentioning

confidence: 99%