RESEARCH - Guillain-Barre and Fisher syndromes occuring with TNF-alpha antagonist therapy

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Arthritis Rheum. 2006 May;54(5):1429-34.

Guillain-Barre and Fisher syndromes occurring with tumor necrosis

factor alpha antagonist therapy.

State University of New York at Buffalo, USA.

OBJECTIVE: Diverse neurologic syndromes have been described in association

with tumor necrosis factor alpha (TNFalpha) antagonist therapy for

inflammatory arthritides and Crohn's disease. The objective of this study

was to review the occurrence and clinical features of Guillain-Barre

syndrome and its variant, the Fisher syndrome, during TNFalpha

antagonist therapy. METHODS: The postmarketing database of the US Food and

Drug Administration (FDA) was searched, following our experience with a

patient with rheumatoid arthritis in whom the Fisher syndrome variant

of the Guillain-Barre syndrome developed while he was receiving infliximab

therapy. RESULTS: Our index patient had a neurologic illness defined

initially by ataxia and dysarthria, which fluctuated in relation to each

subsequent infliximab infusion and, after 6 months, culminated in areflexic

flaccid quadriplegia. In addition, 15 patients in whom Guillain-Barre

syndrome developed following TNFalpha antagonist therapy were identified

from the FDA database. Guillain-Barre syndrome developed following

infliximab therapy in 9 patients, following etanercept therapy in 5

patients, and following adalimumab therapy in 1 patient. Among the 13

patients for whom followup data were available, 1 patient experienced no

resolution, 9 patients had partial resolution, and 3 patients had complete

resolution of Guillain-Barre syndrome following therapy.

CONCLUSION: An association of Guillain-Barre syndrome with TNFalpha

antagonist therapy is supported by the worsening of neurologic symptoms that

occurred in our index patient following each infusion of infliximab, and by

the temporal association of this syndrome with TNFalpha antagonist therapy

in 15 other patients. An acute or subacute demyelinating polyneuropathy

should be considered a potential adverse effect of TNFalpha antagonist

therapy.

PMID: 16645971

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16645971

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