Objective:

To evaluate whether there has been increased use of biologic medications including infliximab, adalimumab, and tocilizumab for the treatment of neurosarcoidosis at our center.

Background:

Sarcoidosis is a granulomatous inflammatory disease of unknown etiology that rarely affects the nervous system as neurosarcoidosis. In recent years, there has been increasing evidence for the use of biologics, including infliximab, adalimumab, and tocilizumab for the maintenance treatment of neurosarcoidosis. Here, we evaluate whether prescribing patterns at our center have shifted toward the use of these drugs or whether most patients remain on more traditional therapies. 

Design/Methods:

Using SlicerDicer (Epic) patients were identified who had an encounter at our center in the past 8 years and carried a diagnosis of “neurosarcoidosis” or “sarcoid meningitis.” From that population, a search was done to see whether patients were on steroid-sparing maintenance medications for treatment of neurosarcoidosis including mycophenolate, methotrexate, azathioprine, cyclophosphamide, cyclosporine, infliximab, adalimumab, or tocilizumab.  

Results:

The number of patients being treated with steroid-sparing agents for neurosarcoidosis has increased over the past 8 years from 18 to 116. For those patients, biologic prescribing has gradually increased (12.5% to 31.9%). This change was largely driven by increased use of infliximab (5.6% to 23.3%) and declining use of mycophenolate (27.8% to 24%). No patients were on tocilizumab while adalimumab prescribing has slightly increased (5.6% to 8.6%).

Conclusions:

This study shows a recent shift toward the use of biologics, particularly infliximab and adalimumab, for the steroid-sparing maintenance treatment of neurosarcoidosis. This change in prescribing patterns likely reflects improved availability of biologic medications and increasing evidence for their use for treating neurosarcoidosis.