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Background <p>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. </p> Methods <p>Patients from four US medical centers with CNS sarcoidosis treated with rituximab were retrospectively studied. After 8&#xa0;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&#xa0;mg daily 6&#xa0;months after initial infusion. </p> Results <p>Nineteen patients were included. At rituximab initiation, duration of neurosarcoidosis was 27.0&#xa0;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&#xa0;g (± 2.8) over 19.0&#xa0;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&#xa0;months (± 13.5), occurring at a median 4.0&#xa0;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.</p> Conclusions <p>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. </p>

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Rituximab in pathologically confirmed sarcoidosis affecting the central nervous system: a multi-center retrospective study

  • 期刊论文

  • 发表日期：

    2025年7月18日

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  • Spencer K. Hutto,
  • Denis Balaban,
  • Zachery Rohm,
  • Elijah Lackey,
  • Rohini D. Samudralwar,
  • Sally El Sammak,
  • Anudeep Nakirikanti,
  • Esther Oyerinde,
  • Gabriela Bou,
  • Max Herman,
  • Lucas Horta,
  • Mohamed Taha,
  • Noellie Rivera Torres,
  • Andrew Morrison,
  • Suma Shah,
  • Siddharama Pawate,
  • Diana Vargas,
  • William Tyor

摘要

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.