{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T03:18:35Z","timestamp":1768101515998,"version":"3.49.0"},"reference-count":27,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the efficacy of tumour necrosis factor-\u03b1 (TNF-\u03b1) inhibitors used as steroid-sparing monotherapy in central nervous system (CNS) parenchymal sarcoidosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The French Multiple Sclerosis and Neuroinflammation Centers retrospectively identified patients with definite or probable CNS sarcoidosis treated with TNF-\u03b1 inhibitors as steroid-sparing monotherapy. Only patients with CNS parenchymal involvement demonstrated by MRI and imaging follow-up were included. The primary outcome was the minimum dose of steroids reached that was not associated with clinical or imaging worsening during a minimum of 3 months after dosing change.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the identified 38 patients with CNS sarcoidosis treated with TNF-\u03b1 inhibitors, 23 fulfilled all criteria (13 females). Treatments were infliximab (n=22) or adalimumab (n=1) for a median (IQR) of 24 (17\u201340) months. At treatment initiation, the mean (SD) age was 41.5 (10.5) years and median (IQR) disease duration 22 (14\u201349.5) months. Overall, 60% of patients received other immunosuppressive agents before a TNF-\u03b1 inhibitor. The mean (SD) minimum dose of steroids was 31.5 (33) mg before TNF-\u03b1 inhibitor initiation and 6.5 (5.5) mg after (p=0.001). In all, 65% of patients achieved steroids dosing &lt;6\u2009mg\/day; 61% showed clinical improvement, 30% stability and 9% disease worsening. Imaging revealed improvement in 74% of patients and stability in 26%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TNF-\u03b1 inhibitors can greatly reduce steroids dosing in patients with CNS parenchymal sarcoidosis, even refractory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Classification of evidence<\/jats:title><jats:p>This study provides Class IV evidence that TNF-\u03b1 inhibitor used as steroid-sparing monotherapy is effective for patients with CNS parenchymal sarcoidosis.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnnp-2020-325665","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T17:54:36Z","timestamp":1623174876000},"page":"890-896","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["TNF-\u03b1 inhibitors used as steroid-sparing maintenance monotherapy in parenchymal CNS 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