The treatment of neurosarcoidosis with cyclosporine.
Six patients with refractory neurosarcoidosis were enrolled in a 12-month open-label trial to investigate the safety and efficacy of cyclosporine therapy. Patients were stabilized on a corticosteroid dose, randomized to a low-dose or high-dose cyclosporine group (with appropriate target whole blood cyclosporine levels) for 6 months, and assessed by prospectively defined studies. The corticosteroid dose was adjusted as clinically tolerated. We found that the corticosteroid dose could be lowered to 30% to 58% of the initial stabilization dose in conjunction with cyclosporine therapy, at the time of maximal clinical and laboratory improvement. However, four patients deteriorated while using corticosteroids and cyclosporine; one of these patients died. At the time of clinical deterioration, the prednisone dose ranged from 6 to 22.5 mg daily (or the equivalent). No serious toxic effects developed from cyclosporine therapy. Cyclosporine treatment is a reasonably safe and effective adjunct to corticosteroid therapy for patients with refractory neurosarcoidosis, although clinical deterioration can occur despite combination therapy.
Stern
B J
BJ
Department of Medicine, Sinai Hospital of Baltimore, MD 21215.
Schonfeld
S A
SA
Sewell
C
C
Krumholz
A
A
Scott
P
P
Belendiuk
G
G
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D016572:Cyclosporine / Q000627:therapeutic use*; D004906:Erythrocyte Count; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D013979:Tibial Nerve / Q000503:physiopathology
D001786:Blood Glucose; D002556:Cerebrospinal Fluid Proteins; D007074:Immunoglobulin G; D016572:Cyclosporine; D007703:Peptidyl-Dipeptidase A; D011241:Prednisone