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@ARTICLE{Nitsch:278784,
      author       = {Nitsch, Louisa and Skowasch, Dirk and Courtin, Edouard and
                      Duffau, Pierre and Otto, Carolin and Ruprecht, Klemens and
                      Dambietz, Christine and Heming, Michael and Meyer Zu
                      Hörste, Gerd and Byg, Keld-Erik and Kindler, Christine and
                      Gutzwiller, Julia and Pretzsch, Roxanne and Pröbstel,
                      Anne-Katrin and Weller, Johannes M and Zimmermann, Julian},
      title        = {{F}actors {A}ssociated {W}ith {R}elapse in {P}atients
                      {W}ith {N}eurosarcoidosis.},
      journal      = {Neurology},
      volume       = {104},
      number       = {11},
      issn         = {0028-3878},
      address      = {Philadelphia, Pa.},
      publisher    = {Wolters Kluwer},
      reportid     = {DZNE-2025-00620},
      pages        = {e213705},
      year         = {2025},
      abstract     = {Five to 10 percent of patients with sarcoidosis show
                      involvement of the nervous system. Given the serious nature
                      of neurosarcoidosis and the high risk of irreversible
                      neurologic damage, rapid diagnosis, accurate
                      prognostication, and individualized treatment are crucial.
                      The aim of this study was to identify factors associated
                      with relapses in neurosarcoidosis.In this multicenter
                      retrospective cohort study, patients diagnosed with
                      possible, probable, or definite neurosarcoidosis between
                      January 1, 2010, and June 30, 2024, at 6 tertiary
                      neuroimmunology centers across Europe were included.
                      Patients were identified from the respective hospital-based
                      databases by the participating centers. Clinical
                      presentation, imaging results, CSF analysis, and
                      immunosuppressive therapies were evaluated. Predictors of
                      relapse, defined as clinical relapse or progression, or new
                      MRI lesions on follow-up ≥2 months after initial
                      manifestation, were analyzed with log-rank tests and Cox
                      regression models, and therapeutic strategies in clinical
                      practice were assessed. The association between identified
                      risk factors (RFs) and therapeutic strategies was explored.A
                      total of 174 patients with neurosarcoidosis were included
                      with a median follow-up of 24 months (interquartile range
                      12-48.8). The mean age was 48.1 years, and $57.5\%$ were
                      female. CNS parenchymal lesions including encephalitis,
                      myelitis, and optic neuritis (hazard ratio [HR] 2.3, $95\%$
                      CI 1.3-4.2); CSF-specific oligoclonal bands (OCBs) (HR 2.1,
                      $95\%$ CI 1.3-3.6); CSF glucose <40 mg/dL (HR 2, $95\%$ CI
                      1.1-3.4); and CSF protein ≥1,000 mg/dL (HR 2.1, $95\%$ CI
                      1.3-3.5) were identified as RFs of relapse. Patients with
                      3-4 RFs had a median relapse-free survival of 12 months
                      $(95\%$ CI 4.3-19.7), compared with 36 months $(95\%$ CI
                      24.3-47.7) in patients with 1-2 RFs and 120 months $(95\%$
                      CI 2.1-237.9) in patients without RFs (p < 0.01). The
                      likelihood of treatment escalation increased with the number
                      of RFs, from $14.3\%$ in patients without RFs to $28.2\%$
                      and $50\%$ in patients with 1-2 or 3-4 RFs, respectively (p
                      < 0.01).The identification of specific RFs, including
                      parenchymal lesions, OCBs, CSF glucose <40 mg/dL, and CSF
                      protein ≥1,000 mg/dL, enables better prognostication and
                      might inform individualized treatment approaches. Patients
                      with multiple RFs are at greater risk of relapse, possibly
                      suggesting the need for more aggressive therapies.},
      keywords     = {Humans / Sarcoidosis: cerebrospinal fluid / Sarcoidosis:
                      diagnostic imaging / Sarcoidosis: epidemiology /
                      Sarcoidosis: drug therapy / Female / Male / Middle Aged /
                      Central Nervous System Diseases: cerebrospinal fluid /
                      Central Nervous System Diseases: diagnostic imaging /
                      Central Nervous System Diseases: epidemiology / Central
                      Nervous System Diseases: drug therapy / Central Nervous
                      System Diseases: diagnosis / Adult / Retrospective Studies /
                      Recurrence / Risk Factors / Magnetic Resonance Imaging /
                      Cohort Studies / Disease Progression / Immunosuppressive
                      Agents: therapeutic use / Immunosuppressive Agents (NLM
                      Chemicals)},
      cin          = {AG Pröbstel},
      ddc          = {610},
      cid          = {I:(DE-2719)1013045},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40373242},
      doi          = {10.1212/WNL.0000000000213705},
      url          = {https://pub.dzne.de/record/278784},
}