Therapeutic considerations in patients with refractory neurosarcoidosis

B. N. Agbogu, B. J. Stern, C. Sewell and G. Yang
Department of Medicine, Sinai Hospital of Baltimore, Md, USA.

OBJECTIVE: To assess the effectiveness of alternative treatments for patients with refractory neurosarcoidosis. DESIGN: Nonrandomized, retrospective patient survey. SETTING: Multicenter, involving patients cared for by their primary physicians and neurologists, and referred for management advice to a neurology consultant. INTERVENTIONS: Patients were treated with corticosteroids and alternative treatments, including azathioprine, cyclosporine, cyclophosphamide, chlorambucil, methotrexate, and radiation therapy. RESULTS: Prednisone dosage was successfully tapered to 10 to 20 mg/d without worsening symptoms in 10 (38%) of the 26 patients studied. Six (23%) patients had improved conditions while receiving alternative medication and nine (35%) patients' conditions remained stable with no further progression of their symptoms. Radiotherapy was beneficial for one of three patients. Four (15%) patients did not respond to alternative treatment and died of worsening symptoms or infection. Adverse effects of the alternate medications resolved on discontinuing treatment with the offending agent. CONCLUSION: Alternative treatment is an effective adjunct to corticosteroid therapy for some patients with refractory neurosarcoidosis. Clinical deterioration may occur despite combined therapy. Choice of alternative therapy should be determined, in part, by its potential adverse effects.