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Authors Gelfand et al. retrospectively reviewed the charts of 66 patients with CNS sarcoidosis treated with infliximab and found that most patients exhibit favorable imaging and clinical treatment responses, including some previously refractory to other immunosuppressive treatments. Commenting on the article, Dr. Avasarala had several questions, including why tumor necrosis factor (TNF)-α blockers fail in multiple sclerosis (MS) and how the extracerebral manifestations of sarcoidosis respond to infliximab. The authors explain that the pathology in MS is different from sarcoidosis, where TNF-α is important for granuloma formation and maintenance. They add that differentiating suspected inflammatory-demyelinating lesions from granulomatous pathologies in the CNS is based on clinical phenotype, MRI appearance, and clinical context. Finally, they clarify that while they did not systemically evaluate treatment responses of infliximab on other organ systems, other studies have shown a benefit.
Authors Gelfand et al. retrospectively reviewed the charts of 66 patients with CNS sarcoidosis treated with infliximab and found that most patients exhibit favorable imaging and clinical treatment responses, including some previously refractory to other immunosuppressive treatments. Commenting on the article, Dr. Avasarala had several questions, including why tumor necrosis factor (TNF)-α blockers fail in multiple sclerosis (MS) and how the extracerebral manifestations of sarcoidosis respond to infliximab. The authors explain that the pathology in MS is different from sarcoidosis, where TNF-α is important for granuloma formation and maintenance. They add that differentiating suspected inflammatory-demyelinating lesions from granulomatous pathologies in the CNS is based on clinical phenotype, MRI appearance, and clinical context. Finally, they clarify that while they did not systemically evaluate treatment responses of infliximab on other organ systems, other studies have shown a benefit.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2018 American Academy of Neurology
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