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October 1992

The Treatment of Neurosarcoidosis With Cyclosporine

Author Affiliations

From the Department of Medicine, Divisions of Neurology (Drs Stern and Krumholz and Ms Sewell) and Pulmonary Medicine (Drs Schonfeld and Scott), Sinai Hospital of Baltimore (Md); the Departments of Neurology (Drs Stern and Krumholz), and Medicine (Dr Schonfeld and Scott), The Johns Hopkins Medical Institutions, Baltimore, Md; and the Sandoz Research Institute, East Hanover, NJ (Dr Belendiuk). Dr Krumholz is currently with the Department of Neurology, University of Maryland at Baltimore; Dr Scott, with the Church Hospital Corporation, Baltimore, Md; and Dr Belendiuk, with Pharmavene Inc, Gaithersburg, Md.

Arch Neurol. 1992;49(10):1065-1072. doi:10.1001/archneur.1992.00530340089023

• Six patients with refractory neurosarcoidosis were enrolled in a 12-month open-label trial to investigate the safety and efficacy of cyclosporine therapy. Patients were stabilized on a corticosteroid dose, randomized to a low-dose or high-dose cyclosporine group (with appropriate target whole blood cyclosporine levels) for 6 months, and assessed by prospectively defined studies. The corticosteroid dose was adjusted as clinically tolerated. We found that the corticosteroid dose could be lowered to 30% to 58% of the initial stabilization dose in conjunction with cyclosporine therapy, at the time of maximal clinical and laboratory improvement. However, four patients deteriorated while using corticosteroids and cyclosporine; one of these patients died. At the time of clinical deterioration, the prednisone dose ranged from 6 to 22.5 mg daily (or the equivalent). No serious toxic effects developed from cyclosporine therapy. Cyclosporine treatment is a reasonably safe and effective adjunct to corticosteroid therapy for patients with refractory neurosarcoidosis, although clinical deterioration can occur despite combination therapy.

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