Journal of neurology · 2025
Rituximab in pathologically confirmed sarcoidosis affecting the central nervous system: a multi-center retrospective study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Hutto Spencer K, Balaban Denis, Rohm Zachery, Lackey Elijah, Samudralwar Rohini D, El Sammak Sally, Nakirikanti Anudeep, Oyerinde Esther, Bou Gabriela, Herman Max, Horta Lucas, Taha Mohamed, Rivera Torres Noellie, Morrison Andrew, Shah Suma, Pawate Siddharama, Vargas Diana, Tyor William
Аннотация
BACKGROUND: Rituximab, a monoclonal antibody that depletes B cells by targeting CD20, has been suggested as a treatment option for neurosarcoidosis, but evidence to support its use is limited.
METHODS: Patients from four US medical centers with CNS sarcoidosis treated with rituximab were retrospectively studied. After 8 weeks of treatment, rituximab failure was defined as a similar inflammatory burden on MRI with persistent symptoms, worsening inflammatory burden on MRI with relevant symptoms, or inability to taper prednisone to less than 10 mg daily 6 months after initial infusion.
RESULTS: Nineteen patients were included. At rituximab initiation, duration of neurosarcoidosis was 27.0 months (± 32.1), mRS was 2.0 (± 1.0), number of preceding attacks was 2 (± 1.8), and treatments previously tried were 1.0 (± 1 0.7). Patients received a median 4 g (± 2.8) over 19.0 months (± 16.8). Rituximab, alone (8/19, 42.1%) or in combination with other immunosuppressants (11/19, 57.9%), was used first or second line in 12/19 (63.2%). Failure occurred in 14/19 (73.7%): relapse or disease progression in 12/14 (85.7%) and failure to spare steroids in 2/14 (14.3%). Median time to first relapse was 7.0 months (± 13.5), occurring at a median 4.0 months (± 2.6) since the last dose. Among the five responsive patients, rituximab was used as third line or later in 4/5 (80.0%), and most (4/5, 80.0%) exhibited multiple cranial neuropathies.
CONCLUSIONS: While rituximab failed in most patients with neurosarcoidosis, a small subset may benefit, particularly those with multiple cranial neuropathies, even after failure of other medications.
METHODS: Patients from four US medical centers with CNS sarcoidosis treated with rituximab were retrospectively studied. After 8 weeks of treatment, rituximab failure was defined as a similar inflammatory burden on MRI with persistent symptoms, worsening inflammatory burden on MRI with relevant symptoms, or inability to taper prednisone to less than 10 mg daily 6 months after initial infusion.
RESULTS: Nineteen patients were included. At rituximab initiation, duration of neurosarcoidosis was 27.0 months (± 32.1), mRS was 2.0 (± 1.0), number of preceding attacks was 2 (± 1.8), and treatments previously tried were 1.0 (± 1 0.7). Patients received a median 4 g (± 2.8) over 19.0 months (± 16.8). Rituximab, alone (8/19, 42.1%) or in combination with other immunosuppressants (11/19, 57.9%), was used first or second line in 12/19 (63.2%). Failure occurred in 14/19 (73.7%): relapse or disease progression in 12/14 (85.7%) and failure to spare steroids in 2/14 (14.3%). Median time to first relapse was 7.0 months (± 13.5), occurring at a median 4.0 months (± 2.6) since the last dose. Among the five responsive patients, rituximab was used as third line or later in 4/5 (80.0%), and most (4/5, 80.0%) exhibited multiple cranial neuropathies.
CONCLUSIONS: While rituximab failed in most patients with neurosarcoidosis, a small subset may benefit, particularly those with multiple cranial neuropathies, even after failure of other medications.