Infliximab effective as adjunctive therapy for patients with central nervous system TB
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Key takeaways:
- Severe disability and all-cause mortality were lower at 6 months among patients given infliximab.
- No infliximab-related side effects were reported during the study.
Infliximab was found to be safe and effective as adjunctive therapy for patients with central nervous system tuberculosis, researchers reported.
“About one-third of patients with central nervous system tuberculosis (CNS TB) worsen despite antitubercular treatment. This phenomenon is called paradoxical worsening and is often due to large inflammatory lesions in the brain or spinal cord,” Abi Manesh, MD, assistant professor in the department of infectious diseases at the Christian Medical College Vellor, told Healio.
“Sometimes, these deteriorations are very severe, resulting in significant disability. Steroids are the most commonly used to treat these worsening neurological deficits, but often patients do not improve. The management options for these patients are unclear,” he said.
According to Manesh, infliximab, a tumor necrosis factor alpha blocker, has been used in a handful of patients with CNS TB across the globe, although the exact benefit and potential harm with this treatment was unclear, leading Manesh and colleagues to conduct a matched retrospective cohort study.
During the study, the researchers systematically studied infliximab treatment among 30 patients with significant disabilities with CNS TB who worsened despite adequate steroids and optimal antitubercular therapy (ATT). Cohort A received at least one dose of infliximab after optimal ATT and steroids, between March 2019 and July 2022, while cohort B received only ATT and steroids. The primary outcome of the study was disability-free survival at 6 months.
Throughout the study, indications for infliximab use were symptomatic tuberculomas (66.7%), spinal cord involvement with paraparesis (26.7%) and optochiasmatic arachnoiditis (10%) worsening despite adequate ATT and steroid treatment.
Among patients who received infliximab, severe disability (16.7% vs. 35%) and all-cause mortality (6.7% vs. 21.7%) were lower than those who did not at 6 months. Additionally, the study showed that in the combined study population, only exposure to infliximab was positively associated with disability-free survival at 6 months (adjusted RR = 6.2; 95% CI, 2.18-17.83).
The researchers also noted that there were no clear infliximab-related side effects reported during the study.
“Infliximab may be considered as an adjunctive therapy among patients with CNS TB who worsen despite appropriate therapy,” Manesh concluded.
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