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

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

Guillain-Barré and Fisher syndromes occurring with tumor

necrosis factor alpha antagonist therapy.

Shin IS, Baer AN, Kwon HJ, Papadopoulos EJ, Siegel JN.

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-Barré 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-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 TNFalpha 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 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/pubmed/16645971

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