RESEARCH - Guillain-Barré and Fisher syndromes occurring with TNF-alpha antagonist therapy

March 8, 2008

Arthritis & Rheumatism

Volume 54, Issue 5, Pages 1429-1434

Published Online: 27 Apr 2006

Research Article

Guillain-Barré and Fisher syndromes occurring with tumor

necrosis factor alpha antagonist therapy

In-Sook J. Shin 1, Alan N. Baer 1 *, Hyon J. Kwon 2, Elektra J.

Papadopoulos 2, N. Siegel 2

1State University of New York at Buffalo

2Center for Drug Evaluation and Research, FDA, Silver Spring, land

Abstract

Objective

Diverse neurologic syndromes have been described in association with

tumor necrosis factor (TNF) antagonist therapy for inflammatory

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

review the occurrence and clinical features of Guillain-Barré syndrome

and its variant, the Fisher syndrome, during TNF 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-Barré 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-Barré

syndrome developed following TNF antagonist therapy were identified

from the FDA database. Guillain-Barré 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-Barré syndrome following therapy.

Conclusion

An association of Guillain-Barré syndrome with TNF 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 TNF antagonist therapy in

15 other patients. An acute or subacute demyelinating polyneuropathy

should be considered a potential adverse effect of TNF antagonist

therapy.

http://www3.interscience.wiley.com/cgi-bin/fulltext/112598663/HTMLSTART

--

Not an MD

March 8, 2008

Yikes! This is why I try to throw away my package inserts w/o reading them! To

the original poster who asked about neurological strangeness w/ Enbrel, last

spring I did get numbness and tingling in my face and hands that necessitated a

referral to neurology. My MRI and physical exam was normal, and it resolved

within about 2 weeks. The confound was that I was switching from prednisone to

dexamethasone, so I'm not sure if that had something to do with it. I hope

you're feeling better and all the numbness has resolved, that must have been so

scary for you. As for Guillain-Barre issue, my husband got it from his flu shot

last year, so I know even tiny things can set off a weird neurological reaction.

Kate F

[ ] RESEARCH - Guillain-Barré and Fisher syndromes

occurring with TNF-alpha antagonist therapy