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Tumour necrosis factor (TNF) inhibitor monotherapy in CNS neurosarcoidosis led to clinical improvement or stability and to a substantial reduction in glucocorticoid exposure, including in patients refractory to other immunosuppressive treatments
While glucocorticoids are widely used as a first-line treatment for neurosarcoidosis, the relatively high doses and cumulative steroid exposure needed to secure remission or an otherwise favourable treatment response can in some cases be excessive, leading to glucocorticoid toxicity, intolerability, and adverse events. A range of steroid-sparing immunosuppressive agents have been used to treat central nervous system (CNS) neurosarcoidosis with variable efficacy and tolerability. The immunologic hallmark of sarcoidosis is a granulomatous inflammatory response, and tumour necrosis factor-α (TNF-α) is important in the pathogenesis of granuloma formation and maintenance. Several case series have reported favourable clinical and imaging benefits with TNF inhibitor therapy for neurosarcoidosis.1–3
In the paper by Hilezian et al,4 the authors add to …
Contributors JMG wrote the invited editorial commentary and is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Research support to UCSF from Genentech/Roche for a clinical trial, consulting for Biogen, personal compensation for medical legal consulting.
Provenance and peer review Commissioned; internally peer reviewed.
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