Demyelinating Syndromes Associated with Anti-TNF alpha Agents: Case Series (P06.182)

Abstract

Objective: To describe clinical and MRI features of demyelinating syndromes associated with anti-tumor necrosis factor agents. Background Anti-TNF alpha agents are used for a variety of autoimmune diseases, including rheumatoid arthritis, psoriasis, inflammatory bowel disease, and sarcoidosis. A few case reports have described CNS demyelination following anti-TNF therapy. However, it is not clear to what extent the CNS is involved nor is the clinical outcome over a longer period of time available for these patients. Design/Methods: Clinical and MRI data from 6 patients is described. These patients were treated with adalimumab (2), etanercept (2), infliximab (2). Demographic characteristics: age range 38-59, 5 females, 1 male. Patients were followed for 1-4 years. Results: Three patients presented with optic neuritis (ON), two with transverse myelitis (TM), and one with asymptomatic CNS lesions. One male patient who presented with ON had a remarkable recovery over 6 months but later developed relapsing demyelinating disease typical of MS. His CSF was positive for oligoclonal bands. The other 2 patients with ON did not further develop any relapses, but one of the patients continued to have severe vision loss with little recovery over 6 months. Two patients with TM also recovered well without any further relapses. All patients except the one with further relapses were negative for oligoclonal bands. Conclusions: CNS demyelination can be a rare complication of anti-TNF alpha therapy. In this series, most patients had a single clinical event and MRI of the brain showed additional T2 lesions some of which were consistent with MS. However, most of the patients that were negative for oligoclonal bands did not develop further demyelinating events. Most patients recovered well from the demyelinating event except one patient. Only 1 of 6 patients who tested positive for oligoclonal bands developed MS. Disclosure: Dr. Williamson has received personal compensation for activities with Accorda Therapeutics as a participant on an advisory board. Dr. Javed has received personal compensation for activities with Teva Neuroscience, Bayer Pharmaceuticals, Serono, Inc., Novartis, Questcor and Biogen Idec as a consultant and/or speaker.