{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:07:39Z","timestamp":1793412459477,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Morbidity associated with central nervous system tuberculosis (CNS TB) remains high due to persistent inflammation despite standard-of-care (SOC) treatment, including antituberculosis therapy and corticosteroids. Tumour necrosis factor alpha (TNF-\u03b1) is a key cytokine driving this inflammatory response, and a limited number of case reports suggest that TNF-\u03b1 inhibitor may improve outcomes. We report the 1-year outcome of a cohort of consecutive patients treated with infliximab for severe CNS TB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Following the guidance provided by the French Tuberculosis Consilium, a standardized regimen of intravenous infliximab at 5 mg\/kg per dose was used to treat CNS TB unresponsive to SOC. We retrospectively included consecutive patients who received at least 1 infliximab injection for CNS TB from 2017 to September 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Eighteen patients with CNS TB, 94% with tuberculous meningitis, were included. Most had severe disease: 82% were classified as British Medical Research Council grade II or III, and 44% required intensive care unit admission. All demonstrated clinical and radiological worsening despite SOC; in 89% due to paradoxical reaction. At infliximab initiation, symptoms remained disabling, with a median modified Rankin Scale (mRS) score of 3.5 (interquartile range, 3-4). One month after the first infusion, 38% showed improved mRS scores, increasing to 78% at 1 year. One-year survival was 94%; one death occurred 12 months after a single infliximab dose and was unrelated to TB treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Infliximab may represent a promising adjunctive treatment for CNS TB unresponsive to SOC, including paradoxical reaction. Prospective studies are needed to confirm these findings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf450","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T11:40:41Z","timestamp":1754739641000},"source":"Crossref","is-referenced-by-count":11,"title":["Standardized Infliximab Regimen to Treat Severe Central Nervous System Tuberculosis: A Case Series of 18 Patients"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1393-9551","authenticated-orcid":false,"given":"Johan","family":"Benhard","sequence":"first","affiliation":[{"name":"Infectious and Tropical Diseases Department, Piti\u00e9-Salp\u00eatri\u00e8re Charles Foix University Hospitals, Sorbonne University, AP-HP, INSERM UMR 1136 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gentiane","family":"Monsel","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Piti\u00e9-Salp\u00eatri\u00e8re Charles Foix University Hospitals, Sorbonne University, AP-HP, INSERM UMR 1136 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9982-4741","authenticated-orcid":false,"given":"Vincent","family":"Dub\u00e9e","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Angers University Hospital, Angers University, Nantes University, INSERM, Immunology and New Concepts in ImmunoTherapy (INCIT) , Angers ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Pavese","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Grenoble University Hospital , Grenoble ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vero","family":"Rasoldier","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Rouen University Hospital , Rouen ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Garrait","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Inter-municipal Hospital Centre , Cr\u00e9teil ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Talleux","sequence":"additional","affiliation":[{"name":"Paediatric Department, Amiens-Picardie University Hospital , Amiens ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3908-7655","authenticated-orcid":false,"given":"Fanny","family":"Vuotto","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Lille University Hospital , Lille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Gueneau","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Bic\u00eatre Hospital, Paris-Saclay University , AP-HP ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Pouget-Abadie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, La Rochelle R\u00e9 Aunis Hospital Group , La Rochelle ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9366-505X","authenticated-orcid":false,"given":"Michael","family":"Thy","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital , AP-HP, Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christia","family":"Palacios","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tenon Hospital , Paris 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Fr\u00e9chet","family":"Jachym","sequence":"additional","affiliation":[{"name":"Sanatorium, Bligny Hospital , Briis-sous-Forges ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3879-1480","authenticated-orcid":false,"given":"Val\u00e9rie","family":"Pourcher","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Piti\u00e9-Salp\u00eatri\u00e8re Charles Foix University Hospitals, Sorbonne University, AP-HP, INSERM UMR 1136 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Veziris","sequence":"additional","affiliation":[{"name":"Centre for Immunology and Infectious Diseases (Cimi-Paris), UMR 1135, Department of Bacteriology, Saint-Antoine Hospital, AP-HP, Sorbonne University, National Reference Centre for Mycobacteria , Paris 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