Long-term course of demyelinating neuropathies occurring during tumor necrosis factor-a-blocker therapy

Abstract

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-α(TNF-α) blocker treatment(infliximab [Remicade], etanercept [Enbrel], and adali- mumab [Humira]).Background: Demyelinating neuropathy is a rare adverse event of anti-TNF-α 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-Bicetre, 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-α 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. Immuno- modulating treatments were always required for neuropathy control. Chronic demyelinating neuropathy developed either after change of anti-TNF-α drug or spontaneously after treatment discontinuation without any drug reintroduction. Conclusion: Influence of anti-TNF-α treatment continuation on the long-term course of neuropathy is variable, suggesting that anti-TNF-α treatment withdrawal is not always necessary for neuropathy control.©2009 American Medical Association.