title: Anti-TNF-α therapy in the management of severe neurosarcoidosis: a report of five cases from a single centre and literature review.
abstract: Neurologic manifestations are found in 5-15 % of patients with sarcoidosis. This granulomatous disease may affect any part of the peripheral or the central nervous system, being potentially severe and difficult to treat. Corticosteroids are the cornerstone of therapy in sarcoidosis. However, some patients become resistant or experience side effects to corticosteroids. In these patients, second line therapies including immunosuppressive drugs such as methotrexate, azathioprine, mycophenolate, cyclophosphamide and leflunomide have been used. Anti-TNF-α drugs have been proposed as a therapeutic option for those who are refractory to immunosuppressive drugs or initially in cases of severe sarcoidosis. We report on 5 patients with neurosarcoidosis treated with anti-TNF-α drugs in our center. A literature review of patients with neurosarcoidosis treated with anti-TNF-α drugs was conducted. In our series successful response to anti-TNF-α therapy was achieved. However, the high frequency of relapses following anti-TNF-α discontinuation makes necessary a close follow-up of these patients when the biologic agent is stopped.
authors: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IFIMAV), University of Cantabria and Centro de Investigacion Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain. leriancho@gmail.com.
authors: L
authors: L
authors: Riancho-Zarrabeitia
authors: M
authors: M
authors: Delgado-Alvarado
authors: J
authors: J
authors: Riancho
authors: A
authors: A
authors: Oterino
authors: M J
authors: MJ
authors: Sedano
authors: J
authors: J
authors: Rueda-Gotor
authors: I
authors: I
authors: Pérez-Martín
authors: M C
authors: MC
authors: González-Vela
authors: J
authors: J
authors: Berciano
authors: M A
authors: MA
authors: González-Gay
authors: R
authors: R
authors: Blanco
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000368:Aged; D001706:Biopsy; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D004351:Drug Resistance; D005260:Female; D006099:Granuloma / Q000276:immunology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D055502:Secondary Prevention; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha