Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides

[Guest guest]

Arthritis Rheum 2001 Dec;44(12):2862-9

Demyelination occurring during anti-tumor necrosis factor alpha therapy

for inflammatory arthritides.

Mohan N, ET, Cupps TR, Oliverio PJ, Sandberg G, Crayton H,

Richert JR, Siegel JN.

town University Medical Center, Washington, DC 20007, USA.

nmohan@...

OBJECTIVE: To review the occurrence of neurologic events suggestive of

demyelination during anti-tumor necrosis factor alpha (anti-TNFalpha)

therapy for inflammatory arthritides. METHODS: The Adverse Events

Reporting System of the Food and Drug Administration (FDA) was queried

following a report of a patient with refractory rheumatoid arthritis who

developed confusion and difficulty with walking after receiving

etanercept for 4 months. RESULTS: Nineteen patients with similar

neurologic events were identified from the FDA database, 17 following

etanercept administration and 2 following infliximab administration for

inflammatory arthritis. All neurologic events were temporally related to

anti-TNFalpha therapy, with partial or complete resolution on

discontinuation. One patient exhibited a positive rechallenge

phenomenon. CONCLUSION: Further surveillance and studies are required to

better define risk factors for and frequency of adverse events and their

relationship to anti-TNFalpha therapies. Until more long-term safety

data are available, consideration should be given to avoiding

anti-TNFalpha therapy in patients with preexisting multiple sclerosis

and to discontinuing anti-TNFalpha therapy immediately when new

neurologic signs and symptoms occur, pending an appropriate evaluation.