{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:07:37Z","timestamp":1793412457111,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Few treatment options exist for patients with severe central nervous system (CNS) tuberculosis (TB) worsening due to inflammatory lesions, despite optimal antitubercular therapy (ATT) and steroids. Data regarding the efficacy and safety of infliximab in these patients are sparse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a matched retrospective cohort study based on Medical Research Council (MRC) grading system and modified Rankin Scale (mRS) scores comparing 2 groups of adults with CNS TB. Cohort A received at least 1 dose of infliximab after optimal ATT and steroids between March 2019 and July 2022. Cohort B received only ATT and steroids. Disability-free survival (mRS score \u22642) at 6 months was the primary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline MRC grades and mRS scores were similar between the cohorts. Median duration before initiation of infliximab therapy from start of ATT and steroids was 6 (IQR: 3.7\u201313) months and for neurological deficits was 4 (IQR: 2\u20136.2) months. Indications for infliximab were symptomatic tuberculomas (20\/30; 66.7%), spinal cord involvement with paraparesis (8\/30; 26.7%), and optochiasmatic arachnoiditis (3\/30; 10%), worsening despite adequate ATT and steroids. Severe disability (5\/30 [16.7%] and 21\/60 [35%]) and all-cause mortality (2\/30 [6.7%] and 13\/60 [21.7%]) at 6 months were lower in cohort A versus cohort B, respectively. In the combined study population, only exposure to infliximab was positively associated (aRR: 6.2; 95% CI: 2.18\u201317.83; P = .001) with disability-free survival at 6 months. There were no clear infliximab-related side effects noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Infliximab may be an effective and safe adjunctive strategy among severely disabled patients with CNS TB not improving despite optimal ATT and steroids. Adequately powered phase 3 clinical trials are required to confirm these early findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciad401","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T09:20:06Z","timestamp":1688030406000},"page":"1460-1467","source":"Crossref","is-referenced-by-count":34,"title":["Effectiveness of Adjunctive High-Dose Infliximab Therapy to Improve Disability-Free Survival Among Patients With Severe Central Nervous System Tuberculosis: A Matched Retrospective Cohort Study"],"prefix":"10.1093","volume":"77","author":[{"given":"Abi","family":"Manesh","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Gautam","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selwyn Selva","family":"Kumar D","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavithra","family":"Mannam","sequence":"additional","affiliation":[{"name":"Department of Radiology, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anitha","family":"Jasper","sequence":"additional","affiliation":[{"name":"Department of Radiology, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Gunasekaran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen Cherian","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit Ninan","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leeberk Raja","family":"Inbaraj","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, ICMR\u2013National Institute for Research in Tuberculosis , Chennai, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Devasagayam","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithun Mohan","family":"George","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Karthik","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ooriapadickal Cherian","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshad A","family":"Vanjare","sequence":"additional","affiliation":[{"name":"Department of Radiology, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajith","family":"Sivadasan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhakar Thirumal","family":"Appaswamy","sequence":"additional","affiliation":[{"name":"Department of Neurology, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmond","family":"Jonathan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy S","family":"Michael","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasanna","family":"Samuel","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M","family":"Varghese","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College , Vellore, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,5]]},"reference":[{"key":"2023111710144159900_ciad401-B1","article-title":"Treatment outcomes in adult tuberculous meningitis: a systematic review and meta-analysis","volume":"7","author":"Stadelman","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2023111710144159900_ciad401-B2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/17512433.2019.1552831","article-title":"Intensified antibiotic 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