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Anti-TNF Agent Linked to Case of New-Onset of Multiple Sclerosis

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WESTPORT, CT (Reuters Health) Dec 07 - A case report suggests that exposure to

anti-TNF drugs might trigger multiple sclerosis.

In a paper published in the current issue of Neurology dated November 27, Dr.

L. Sicotte and a colleague from the University of California at Los

Angeles note that previous reports have shown that therapies aimed at inhibiting

tumor necrosis factor (TNF) can worsen multiple sclerosis (MS) or cause isolated

demyelinating events. Now it seems that anti-TNF agents might cause recurrent

demyelinating events or multiple sclerosis even after the drug has been

withdrawn.

The clinicians describe a 21-year-old woman with new onset MS " closely

associated " with the start of treatment with etanercept (Enbrel: Immunex) for

refractory juvenile rheumatoid arthritis. The patient had no family history for

MS.

Nine months into etanercept treatment, the patient complained of pain and

decreased vision in her right eye and was diagnosed with optic neuritis. The

pain resolved and her vision returned to normal following a 5-day course of

high-dose IV methylprednisolone.

Two months later, the patient had no new symptoms but new disease activity was

apparent on cerebral MRI. Despite discontinuing etanercept at this time, the

patient developed new enhancing lesions and neurologic symptoms over the next 6

weeks and met criteria for " clinically definite relapsing remitting MS, " the

authors report.

It is entirely possible, they say, that the use of etanercept and development of

MS were coincidental in this patient. It is also quite possible that the drug

either triggered latent or undiagnosed MS or caused MS to develop. The fact that

the woman was on etanercept for 9 months before the first attack suggests that

she did not have undiagnosed MS, the team writes.

Immunex has received a number of reports of CNS demyelination associated with

etanercept treatment, which led them to issue a drug warning in October 2000.

" Clinicians who prescribe these types of drugs should be aware of this potential

side effect and should closely monitor patients who develop demyelination to

determine if more events occur, " Dr. Sicotte said. " This case is interesting

because understanding why certain individuals develop demyelination and/or

multiple sclerosis while receiving anti-TNF therapy may provide insight into the

pathogenesis of multiple sclerosis, " she added.