Remicade Treatment Appears to Benefit Patients with Neurosarcoidosis, Study Finds

Remicade Treatment Appears to Benefit Patients with Neurosarcoidosis, Study Finds

Treatment with Remicade (infliximab) in neurosarcoidosis patients is associated with favorable imaging and clinical treatment responses, new research shows.

The study, “Infliximab for the treatment of CNS sarcoidosis,” was published in the journal Neurology.

Neurosarcoidosis occurs in about 5% to 15% of patients with sarcoidosis and can be associated with higher rates of morbidity. Generally, patients are treated with steroids; however, the doses that are necessary to achieve and sustain an optimal response can be prohibitive due to disease severity or the toxicity of the drugs.

Immunosuppressive treatments that don’t involve steroids have also had variable success in patients with this disease. Unfortunately, randomized clinical trials on patients with sarcoidosis in the central nervous system (CNS) have not been conducted.

Remicade is a monoclonal antibody against the tumor necrosis factor-alpha (TNF-alpha), which is a factor involved in the inflammatory response. Remicade has emerged as a new neurosarcoidosis treatment, including patients who have refractory (unresponsive) disease.

The use of Remicade in neurosarcoidosis has not been studied in more than a single patient or a small case series. Therefore, researchers from six centers in the United States gathered to retrospectively analyze patients with neurosarcoidosis who received treatment with Remicade. Patients with both definite and probable neurosarcoidosis diagnoses were assessed in the study.

In total, researchers analyzed 66 patients with CNS sarcoidosis (27 with definite, and 39 with probable diagnosis) treated with Remicade for a median of 1.5 years. Sarcoidosis was isolated to the central nervous system in 19.7% of the patients.

MRI results showed a favorable treatment response in 82.1% of the patients. There was complete remission of active disease, according to the MRI in 51.8%, and partial MRI improvement in 30.1% of the patients. One patient exhibited a worsened MRI condition after treatment.

Clinically, 77.3% of patients demonstrated improvement, with 28.8% demonstrating complete neurologic recovery, 48.5% showing partial improvement, 18.2% demonstrating clinical stability, and 3% showing a worsened condition.

In cases in which Remicade treatment was discontinued, which occurred in 16 patients out of the 66, nine of the 16 patients experienced disease recurrence.

“Most patients with CNS sarcoidosis treated with infliximab [Remicade] exhibit favorable imaging and clinical treatment responses,” the researchers said.

“Studies will be needed to determine the comparative risk of infliximab to other disease-modifying agents in neurosarcoidosis and what dose, frequency, and treatment combinations are optimal for neurosarcoidosis,” the team added.

2 comments

  1. Pamela J Veal says:

    My name is Pamela Veal. I was diagnosed with neurosarcoidosis, CNS involvement March of 2016. So far, I’ve received Remicade infusion every 6-8 week since May 2016. I am also on Prednisone, 5mg per day and Methotrexate, 10mg per week. My MRIs have been clear of gradulomas since May 2016. Although I seem to bee clear of gradulomas, I have nerve damage; dizziness balance/gait compromised which is triggered by my movement; The more I move, the dizzier I become. Doctor, do you have other neurosarcoidosis patient with similar symptoms?

  2. Chris says:

    I was diagnosed with Neurosarcoidosis in October 2011 by the Mayo Clinic in Rochester, MN. I am 53 years old and have nerve damage in my limbs due to the initial attack in 2011. I was on 60 mg of Prednisone for over a year (11/11-11/12). I have tried Actar three times in 2015/16 when I thought I was getting worse but it doesn’t seem to help much. I can walk but stumble quite often. My arms are stronger than my legs. Do you think I might benefit from a Remicade treatment and should therefore ask my doctor about it?

    Thanks!

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