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Abstract Details

Adalimumab for the Treatment of CNS Sarcoidosis
Autoimmune Neurology
P1 - Poster Session 1 (12:00 PM-1:00 PM)
048
To evaluate the use of adalimumab for CNS sarcoidosis in a retrospective case series
In observational analyses, infliximab, an infused chimeric antibody inhibiting tumor necrosis factor-alpha, appears to provide benefit in the treatment of CNS sarcoidosis, including in patients with refractory disease. Potential obstacles to treatment include the need for an infusion infrastructure and risk of developing neutralizing anti-drug antibodies that impair drug function. Adalimumab is an injectable humanized monoclonal antibody TNF inhibitor, but the data supporting its use in neurosarcoidosis is limited.
Patients with definite or probable CNS sarcoidosis treated with adalimumab were retrospectively identified.

Nine patients were included (median age 47.0; male 55.6%;Black 77.8%, White 11.1%, race unreported 11.1%; extra-neurologic systemic sarcoidosis 100%) and diagnostically supported by systemic (66.7%) and neurologic (33.3%) biopsies. Median follow-up duration was 26 months following initiation of adalimumab with no patients lost to follow-up while using adalimumab.

The most common phenotypes were cranial leptomeningitis(66.7%), myelitis (55.6%), hypothalamic disease (33.3%), and brain parenchymal lesions (33.3%). Median pre-adalimumab disease characteristics included: neurosarcoidosis disease duration 58 months, 2 prior attacks, mRS 2, EDSS 3.5, and 2 prior immunosuppressants (including 5 treated with infliximab).  Treatment details included: none using loading doses, 88.9% maintained on 40 mg every other week, 11.1% maintained on 40 mg every week; 55.6% using concomitant immunosuppression; and median adalimumab treatment duration of 6 months. Two patients (22.2%) exhibited breakthrough disease at 2 and 6 months. Five patients (55.6%) discontinued adalimumab, and relapses occurred in 2 patients 3 months after adalimumab discontinuation.
In this relatively small retrospective dataset, most patients (77.8%) responded favorably to adalimumab, including an arrayof CNS phenotypes, those with disease refractory to other treatments, and those with prolonged disease. There was a relapse of neurosarcoidosis in 40% of patients (2 of 5) within 3 months after stopping adalimumab.
Authors/Disclosures
Avi Singh Gandh, MD
PRESENTER 		Dr. Gandh has nothing to disclose.
Jeffrey M. Gelfand, MD, MS, FAAN (University of California, San Francisco) Dr. Gelfand has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Arialys. Dr. Gelfand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ventyx Bio. An immediate family member of Dr. Gelfand has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Headache: The Journal of Head and Face Pain. The institution of Dr. Gelfand has received research support from Genentech/Roche. The institution of Dr. Gelfand has received research support from Vigil Neurosciences. An immediate family member of Dr. Gelfand has received publishing royalties from a publication relating to health care. Dr. Gelfand has received publishing royalties from a publication relating to health care. Dr. Gelfand has received publishing royalties from a publication relating to health care. Dr. Gelfand has a non-compensated relationship as a Trial Steering Committee Chairperson and member with Roche / Genentech that is relevant to AAN interests or activities.
Spencer Hutto, MD (Emory University: Neurology Residency Program) Dr. Hutto has nothing to disclose.