The objective of this project is to better characterize patients with neurosarcoidosis that are able to discontinue Infliximab therapy without disease relapse.

Neurosarcoidosis is an inflammatory condition affecting the central nervous system with a variable clinical course. Many patients have a relapsing remitting or a progressive course of disease. Some patients are treated with Infliximab and are eventually able to stop therapy.

We conducted a retrospective analysis of a cohort of patients with neurosarcoidosis who received care at Duke University Hospital in the past ten years and were treated with Infliximab therapy. Eighty patients were initially identified, and 68 patients met inclusion criteria after chart review. Data was analyzed using descriptive statistics.

Out of a cohort of 68 patients, 28 discontinued Infliximab therapy. Reasons for discontinuation include completion of therapy (12, 43%), adverse events (11, 39%), and ineffective (5, 18%). Forty patients remain on Infliximab therapy, including 3 patients that relapsed after Infliximab discontinuation. Within the subgroup of patients that successfully completed therapy without disease relapse, the average age at time of neurosarcoidosis diagnosis was 44.1 years. There were 5 females (42%) and 7 males (58%), and the majority were African Americans (83%). Most patients were receiving concurrent therapy with a different agent at the time of Infliximab discontinuation (17% methotrexate, 42% prednisone, 33% a combination of methotrexate and prednisone, 8% no concurrent therapy), although 3 patients were later able to discontinue all therapy (25%). The average duration of Infliximab therapy was 992 days. The average duration of follow up since Infliximab initiation was 2719 days and the average duration of follow up since Infliximab discontinuation was 1740 days. 

In some patients with neurosarcoidosis, it may be possible to discontinue Infliximab without disease relapse. Individualized care is essential, as some patients may need to remain on Infliximab therapy long-term.