Demyelination occurring during anti-tumor necrosis factor ? therapy for inflammatory arthritides

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Abstract
To review the occurrence of neurologic events suggestive of demyelination during anti–tumor necrosis factor α (anti-TNFα) therapy for inflammatory arthritides. The Adverse Events Reporting System of the Food and Drug Administration (FDA) was queried following a report of a patient with refractory rheumatoid arthritis who developed confusion and difficulty with walking after receiving etanercept for 4 months. Nineteen patients with similar neurologic events were identified from the FDA database, 17 following etanercept administration and 2 following infliximab administration for inflammatory arthritis. All neurologic events were temporally related to anti-TNFα therapy, with partial or complete resolution on discontinuation. One patient exhibited a positive rechallenge phenomenon. Further surveillance and studies are required to better define risk factors for and frequency of adverse events and their relationship to anti-TNFα therapies. Until more long-term safety data are available, consideration should be given to avoiding anti-TNFα therapy in patients with preexisting multiple sclerosis and to discontinuing anti-TNFα therapy immediately when new neurologic signs and symptoms occur, pending an appropriate evaluation.