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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 wholoe blood cyclosporine levels)for 6 months,and assessed by prospectively defined studies.The corticosteroid dose was adjusted as clinically tolerated.We found that the cortocosteroid 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 efefctive adjunct to corticosteroid therapy for patients with refractory neurosarcoidosis, although clinical deterioration can occur despite combination therapy. |
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