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 …