Impact of clinical presentation and time to start of infliximab on disability outcomes in neurosarcoidosis

<h3>Background</h3> TNF alpha inhibitor infliximab has emerged as a treatment option in refractory neurosarcoidosis (NS). However, no studies to date have been performed in patients with NS to determine neurological presentations that would be most suitable for early escalation to infliximab. <h3>Methods</h3> We conducted a retrospective study of biopsy-proven NS patients treated with infliximab who met a predetermined expert led inclusion criteria based on clinical presentation. Modified Rankin Score (MRS) was recorded prior to initiation and at first follow up after commencement of infliximab. Time to start of infliximab from baseline was also recorded. <h3>Results</h3> Twenty-two patients with biopsy proven NS were included. The commonest presentation was spinal cord disease (n=11; 50%). The median time from symptom onset to infliximab was 20 months (IQR, 12 to 31). Majority showed improved MRS at follow-up between 1–3 points. The median time from disease onset to infliximab was 20 months. (IQR, 9 to 31). There was no difference in change of MRS between those with &lt;2 vs. ≥2 presentations. <h3>Discussion</h3> Commencement of infliximab is the single most important factor that led to improvement in follow up disability scores in NS. Other factors such as type of clinical presentation and time from disease onset to start of infliximab did not impact disability outcome.