Standardized Infliximab Regimen to Treat Severe Central Nervous System Tuberculosis: A Case Series of 18 Patients

Abstract Background Morbidity associated with central nervous system tuberculosis (CNS TB) remains high due to persistent inflammation despite standard-of-care (SOC) treatment, including antituberculosis therapy and corticosteroids. Tumor necrosis factor alpha (TNF-α) is a key cytokine driving this...

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Vydané v:	Open forum infectious diseases Ročník 12; číslo 8; s. ofaf450
Hlavní autori:	Benhard, Johan, Monsel, Gentiane, Dubée, Vincent, Pavese, Patricia, Rasoldier, Vero, Garrait, Valérie, Talleux, Marie, Vuotto, Fanny, Gueneau, Romain, Pouget-Abadie, Xavier, Thy, Michael, Palacios, Christia, Bachir, Marwa, Djossou, Felix, Tunesi, Simone, Jachym, Mathilde Fréchet, Pourcher, Valérie, Veziris, Nicolas, Bourgarit, Anne
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	US Oxford University Press 01.08.2025
Predmet:	Life Sciences Meningitis Microbiology and Pathogenesis Morbidity Nervous system Tuberculosis Tumor necrosis factor-TNF central nervous system tuberculosis infliximab paradoxical reaction tuberculous meningitis TNF-α inhibitor
ISSN:	2328-8957, 2328-8957
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Shrnutí:	Abstract Background Morbidity associated with central nervous system tuberculosis (CNS TB) remains high due to persistent inflammation despite standard-of-care (SOC) treatment, including antituberculosis therapy and corticosteroids. Tumor necrosis factor alpha (TNF-α) is a key cytokine driving this inflammatory response, and a limited number of case reports suggest that TNF-α inhibitors may improve outcomes. We report the 1-year outcome of a cohort of consecutive patients treated with infliximab for severe CNS TB. Methods Following the guidance provided by the French Tuberculosis Consilium, a standardized regimen of intravenous infliximab at 5 mg/kg per dose was used to treat CNS TB unresponsive to SOC. We retrospectively included consecutive patients who received at least 1 infliximab injection for CNS TB from 2017 to September 2021. Results Eighteen patients with CNS TB, 94% with tuberculous meningitis, were included. Most had severe disease: 82% were classified as British Medical Research Council grade II or III, and 44% required intensive care unit admission. All demonstrated clinical and radiological worsening despite SOC; in 89% due to paradoxical reaction. At infliximab initiation, symptoms remained disabling, with a median modified Rankin scale (mRS) score of 3.5 (interquartile range, 3–4). One month after the first infusion, 38% showed improved mRS scores, increasing to 78% at 1 year. One-year survival was 94%; 1 death occurred 12 months after a single infliximab dose and was unrelated to TB treatment. Conclusions Infliximab may represent a promising adjunctive treatment for CNS TB unresponsive to SOC, including paradoxical reaction. Prospective studies are needed to confirm these findings. Infliximab, a TNF-α inhibitor, is a promising adjunctive therapy for severe central nervous system tuberculosis unresponsive to standard of care. In this case series of 18 patients, 78% clinically improved within 1 year, with a survival rate of 94%, warranting further prospective studies.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 PMCID: PMC12351261 Potential conflicts of interest. N. V. involved in the RespiriTB consortium in association with Janssen.
ISSN:	2328-8957 2328-8957
DOI:	10.1093/ofid/ofaf450