Long-term outcomes of refractory neurosarcoidosis treated with infliximab

J Neurol. 2017 May;264(5):891-897. doi: 10.1007/s00415-017-8444-9. Epub 2017 Mar 4.


Central nervous system localizations of sarcoidosis may be refractory to conventional treatment such as steroids and immunosuppressive drugs. Infliximab, a TNF-α antagonist chimeric antibody, has been shown to be effective for treatment of these localizations. The aim of this study was to evaluate the efficacy and safety, in particular the long-term outcomes, of the use of infliximab for the treatment of neurosarcoidosis. We retrospectively reviewed medical records of patients with neurosarcoidosis who had been treated with infliximab between 2009 and 2015. All patients had histologically proven non-caseating granulomas. Eighteen patients with histologically proven sarcoidosis were included in this study. All had neurological involvement consisting of meningeal (n = 16), cerebral (n = 10), spinal cord (n = 6), and/or optic nerve (n = 5) involvement. Sixteen patients had previously received at least one immunosuppressive drug in addition to corticosteroids, including cyclophosphamide in 11 patients. All patients received treatment with infliximab (3-7.5 mg/kg) associated with corticosteroids (n = 18), low-dose methotrexate (n = 15), azathioprine (n = 2), or mycophenolate (n = 1). Sixteen out of 18 patients improved clinically (initial median modified Rankin scale score of 3, final median score of 1; p < 0.0001). At 6 months after initiation of infliximab, six patients obtained complete remission (33%), ten attained partial remission (56%), and two had stable disease (11%). The median follow-up time was 20 months (range 6-93). Nine patients relapsed during follow-up (50%). Eight patients developed toxic side effects and seven of these side effects were infectious events. Infliximab is an efficacious treatment of refractory neurosarcoidosis. However, relapses frequently occurred during follow-up.

Keywords: Infliximab; Neurosarcoidosis; Relapses; Side effects.

MeSH terms

  • Adult
  • Aged
  • Antirheumatic Agents / therapeutic use*
  • Central Nervous System Diseases / drug therapy*
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infliximab / therapeutic use*
  • Longitudinal Studies
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Retrospective Studies
  • Sarcoidosis / drug therapy*
  • Severity of Illness Index
  • Treatment Outcome*


  • Antirheumatic Agents
  • Immunosuppressive Agents
  • Infliximab
  • Methotrexate

Supplementary concepts

  • Neurosarcoidosis