Objective:

Here we reviewed the use of adalimumab for treatment of neurosarcoidosis, and the risk of adverse complications in patients at our center.

Background:

Among emerging therapeutic options, adalimumab has shown promise in treating neurosarcoidosis. It is approved for a variety of inflammatory conditions including rheumatoid arthritis, psoriatic arthritis, and hidradenitis suppuritiva. Adalimumab is a fully-human, immunoglobulin G monoclonal antibody that targets tumor necrosis factor-alpha (TNF-α), a pro-inflammatory cytokine implicated in the pathogenesis of sarcoidosis. The efficacy of adalimumab in neurosarcoidosis can further treatment options, especially in cases refractory to other treatments. 

Design/Methods:

Retrospective chart review of patients seen in the Duke Multiple Sclerosis and Neuroimmmunology clinic, identified using SlicerDicer and by reviewing provider lists. We reviewed patients who were treated with adalimumab for neurosarcoidosis and were on therapy for at least one month.  

Results:

Eight cases of neurosarcoidosis were treated with adalimumab. Of these, 3 met criteria for possible, 4 probable, and 1 definite neurosarcoidosis. Duration of therapy ranged between 1 month to 76 months (about 6 and a half years). The most common dosage was 40 mg/week (6 patients), one received 80mg/week and another received 40mg/2 weeks. None of the 8 patients had side effects directly attributable to adalimumab, however, one discontinued adalimumab after 31 months (about 2 and a half years) due to worsening MRI changes.  

Conclusions:

The observed improvements in clinical symptoms and radiographic findings suggest its therapeutic efficacy, especially in cases refractory to other treatments. All patients in our study, who received adalimumab were able to tolerate the therapy without major adverse effects, although increased risk of serious infections was noted. As we continue to refine our understanding of this complex disorder, adalimumab's targeted immunomodulation offers a promising avenue for managing the challenging landscape of neurosarcoidosis treatment.