RESEARCH - Long-term course of demyelinating neuropathies during TNF blocker therapy

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Arch Neurol. 2009 Apr;66(4):490-7.

Long-term course of demyelinating neuropathies occurring during tumor

necrosis factor-alpha-blocker therapy.

Lozeron P, Denier C, Lacroix C, D.

Department of Neurology, Assistance Publique-Hôpitaux de Paris,

Université Paris Sud, France.

OBJECTIVE: To report the long-term follow-up (mean, 41 months; range,

25-55 months) of patients with demyelinating neuropathy occurring

after tumor necrosis factor-alpha (TNF-alpha) blocker treatment

(infliximab [Remicade], etanercept [Enbrel], and adalimumab [Humira]).

BACKGROUND: Demyelinating neuropathy is a rare adverse event of

anti-TNF-alpha therapy. Improvement usually occurs after drug

interruption and/or in association with usual treatments for

demyelinating neuropathies. DESIGN: Case report with review of the

previously published cases.

SETTING: University hospital in Le Kremlin-Bicêtre, France: tertiary

reference center for peripheral neuropathies and national reference

center for rare peripheral neuropathies (www.nnerf.fr).

PATIENTS: Five patients (4 men, mean age, 47 years) who developed a

demyelinating neuropathy during anti-TNF-alpha therapy.

MAIN OUTCOME MEASURE: Development of neuropathy. RESULTS: Neuropathy

developed early (8 months) after treatment introduction. Various

clinical patterns were encountered, including pure sensory neuropathy.

Immunomodulating treatments were always required for neuropathy

control. Chronic demyelinating neuropathy developed either after

change of anti-TNF-alpha drug or spontaneously after treatment

discontinuation without any drug reintroduction.

CONCLUSION: Influence of anti-TNF-alpha treatment continuation on the

long-term course of neuropathy is variable, suggesting that

anti-TNF-alpha treatment withdrawal is not always necessary for

neuropathy control.

PMID: 19364934

http://www.ncbi.nlm.nih.gov/pubmed/19364934

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