Infliximab Reported as Effective Therapy for Neurosarcoidosis, But Patients Often Relapse

Infliximab effectively treats neurosarcoidosis, but patients may see their disease return (relapse) over time, according to results of a new study.

The study, “Long-Term Outcomes Of Refractory Neurosarcoidosis Treated With Infliximab,” was published in the Journal of Neurology.

Neurosarcoidosis (sarcoidosis affecting the nervous system) may be resistant to treatments such as steroids and immunosuppressive drugs, which usually are effective in other forms of sarcoidosis.

Previous studies have shown that infliximab, an antibody that blocks the TNF-α protein (involved in sarcoidosis development), may be an effective treatment for neurosarcoidosis.

To investigate the long-term efficacy and safety of infliximab in neurosarcoidosis, researchers analyzed the medical records of 18 patients treated with this drug between 2009 and 2015. All patients had neurological problems due to sarcoidosis, with meningeal (16 patients), cerebral (10), spinal cord (six), and/or optic nerve (five) involvement.

From the initial group of patients, 16 had been treated with at least one immunosuppressive drug in addition to corticosteroids, including cyclophosphamide. All patients received treatment with infliximab (3-7.5 mg/kg) combined with other therapies, such as corticosteroids (18 patients), low-dose methotrexate (15), azathioprine (two), or mycophenolate (one).

Results showed that treatment with infliximab provided a clinical improvement in 16 patients. Six months after the therapy’s start, six patients (33%) had a complete neurological remission, 10 (56%) had a partial response, and two (11%) had stable disease.

However, during follow-up (median period of 20 months), half of the patients relapsed and eight patients reported adverse side-effects, of which seven cases were infections.

Together, these results show that infliximab is effective as a therapy for neurosarcoidosis, but patients frequently may relapse over time.

“Infliximab displayed a high rate of efficacy (89%), although sometimes it is given as a 4th line immunosuppressive therapy,” researchers wrote. “However, the results from this study show a high rate of relapse (50%) during follow-up, including patients who were receiving TNF-a antagonist treatment (35%), and despite maintenance therapy in others. The safety profile of infliximab for management of neurosarcoidosis was marked by the occurrence of infectious events (39%), possibly facilitated by a history of several lines of immunosuppressive treatments more than cumulative infliximab treatment.”

“In conclusion, administration of infliximab seems to be an efficacious treatment for refractory neurosarcoidosis but has a high rate of relapse. Prospective studies to examine combined therapies and treatment duration should be considered” the team concluded.

Infliximab is marketed under the brand names Remicade and Inflectra, and it has been approved for the treatment of several inflammatory conditions, such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis and plaque psoriasis.