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SAT0121 High incidence of demyelinising neurological disease after anti TNF-alpha treatment in a rheumatological population
  1. A. Theibich1,
  2. H. Locht1,
  3. L. Drejer2
  1. 1Reumatology, Frederiksberg Hospital
  2. 2Reumatology, Gentofte, Copenhagen N, Denmark

Abstract

Background Biological treatment with inhibitors of the pro-inflammatory cytokine TNF-alpha has dramatically improved the disease course of several chronic rheumatologic conditions. Adverse events (AE) are primarily infections and hypersensitivity reactions. Demyelinising neurological symptoms resembling multiple sclerosis (MS) has been described and considered a rare AE. During about 10-years use of anti TNF compounds the Danish Medicines Agency has registered 8 cases of MS like AEs.

Objectives To estimate the incidence of demyelinising neurological AEs both in the central and peripheral nervous system after treatment with TNF inhibitors in a cohort of patients from a large rheumatological out-patients clinic in Copenhagen.

Methods In a 2-year period from January 2010 – December 2011 approximately 500 patients were undergoing treatment with TNF-alpha blockers in our Department. We collected data on all patients who developed neurological symptoms during this time period.

Results We found 6 patients with signs of demyelinising neurological disorders. Four resembling MS, 1 MS-like condition, and 1 multifocal motor neuropathy (Table).

Conclusions During a relatively short time period we found a remarkably high number of neurological demyelinising AEs probably linked to anti TNF-alpha treatment. The AEs were not associated with a single anti TNF-alpha agent and therefore probably due to a class-effect. The data presented suggest that neurological AEs may be under-reported. We advocate that physicians handling patients during treatment with TNF inhibitors are aware of this potentially serious AE and report these events to the proper medicinal authorities.

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  3. Kollias, E Douni, G Kassiotis, et al. The function of tumor necrosis factor and receptors in models of multi-organ inflammation, rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease. Ann Rheum Dis. 1999;58(suppl 1):132–139.

  4. M Tanno, I Nakamura, S Kobayshi et al. New-Onset demyelination induced by Infliximab Therapy in two Rheumatoid Arthritis Patients. Clin. Rheumatol. 2006;25(6):929-933.

Disclosure of Interest None Declared

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