Infliximab therapy rescues cyclophosphamide failure in severe central nervous system sarcoidosis.
Central nervous system involvement is a severe manifestation of sarcoidosis that often requires aggressive immunosuppressive therapy. The most efficacious approach for refractory disease is unknown. We reviewed the cases of four subjects who demonstrated active progression of neurosarcoidosis while under treatment with cyclophosphamide, and who were subsequently treated with infliximab. All four subjects demonstrated rapid and substantial reversal of their clinical course. Radiologic findings were concordant with the clinical responses. There were no notable toxicities. Treatment with infliximab may be more effective than cyclophosphamide for refractory central nervous system sarcoidosis. A larger, prospective study is warranted.
Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. sodhim@ccf.org
Manica
M
Sodhi
Karla
K
Pearson
Eric S
ES
White
Daniel A
DA
Culver
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D002493:Central Nervous System Diseases / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018450:Disease Progression; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000069285:Infliximab; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016879:Salvage Therapy / Q000379:methods*; D012507:Sarcoidosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D003520:Cyclophosphamide; D000069285:Infliximab