Discontinuation of Infliximab in Neurosarcoidosis

Objective The objective of this project is to better characterize patients with neurosarcoidosis that discontinue infliximab therapy without disease relapse. Background 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. Design/Methods We conducted a retrospective analysis of a cohort of patients with neurosarcoidosis who received care at Duke University Hospital over a ten-year period (2014–2024) 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. Results Out of a cohort of 68 patients, 31 discontinued infliximab therapy. Reasons for discontinuation include completion of therapy (15, 48%), adverse events (11, 36%), and ineffective (5, 16%). Among the patients who completed therapy, 3 patients experienced disease relapse prompting resumption of therapy (20% relapse rate), whereas 12 patients remained off infliximab long-term. Within the subgroup of patients that successfully completed therapy without disease relapse, the majority were male (58%) and African American (83%), with an average age at diagnosis of 44.1 years. Most patients were receiving concurrent therapy at the time of infliximab discontinuation (17% methotrexate, 42% prednisone, 33% methotrexate and prednisone, 8% no concurrent therapy), although 3 patients later discontinued all therapy. The average duration of infliximab therapy was 2.7 years (992 days), and the average duration of follow-up since infliximab discontinuation was 4.8 years (1740 days). Conclusions In this cohort of patients with neurosarcoidosis, 12 of 15 patients (80%) who completed infliximab therapy remained relapse-free over an average follow-up of 4.8 years, suggesting that successful discontinuation is achievable in a subset of patients. Individualized care is essential, as some patients may need to remain on infliximab therapy long-term.