Inflammatory neurological disease in patients treated with tumor necrosis factor alpha inhibitors

Andrew J. Solomon, Rebecca Spain, Michael C. Kruer, Dennis Bourdette

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: TNF alpha inhibitor (TNFAI) therapy has been associated with inflammatory neurological syndromes.Objectives: To present 10 new cases of TNFAI associated neurological disease and a review of the literature.Methods: The design and methods were based on case series collected from Oregon Health & Sciences University and the Department of Veterans Affairs Hospital in Portland, Oregon and PubMed review.Results: We describe eight demyelinating central nervous system syndromes and two peripheral nervous system syndromes associated with TNFAI therapy. Characteristics from these cases are analyzed with data from 141 additional cases from the literature. Onset was between the ages of 36 and 65 years in 84% of CNS cases, distinguishing TNFAI-associated disease from sporadic multiple sclerosis. Symptoms occurred within one year of TNFAI therapy in 71%. Etanercept therapy was reported in the majority of cases of CNS syndromes and infliximab therapy in the majority of neuromuscular syndromes. Significant disability remained in 67% of cases although 82% had been followed for less than one year.Conclusions: Our case series and literature review demonstrates an association between TNFAI therapy and inflammatory neurological disease. While a causal relationship is suggested, this remains uncertain. TNFAI-associated neurological syndromes are associated with significant disability and longer follow-up is needed to better determine natural history and evaluate appropriate treatment interventions.

Original languageEnglish (US)
Pages (from-to)1472-1487
Number of pages16
JournalMultiple Sclerosis
Volume17
Issue number12
DOIs
StatePublished - 2011

Fingerprint

Tumor Necrosis Factor-alpha
Therapeutics
Veterans Hospitals
Peripheral Nervous System
Natural History
PubMed
Multiple Sclerosis
Central Nervous System
Health

Keywords

  • antagonist
  • demyelination
  • inhibitor
  • multiple sclerosis
  • neuropathy
  • optic neuritis
  • tumor necrosis factor alpha

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Inflammatory neurological disease in patients treated with tumor necrosis factor alpha inhibitors. / Solomon, Andrew J.; Spain, Rebecca; Kruer, Michael C.; Bourdette, Dennis.

In: Multiple Sclerosis, Vol. 17, No. 12, 2011, p. 1472-1487.

Research output: Contribution to journalArticle

@article{6b5c1e15f6ff4a61bc0480842e57cd2d,
title = "Inflammatory neurological disease in patients treated with tumor necrosis factor alpha inhibitors",
abstract = "Background: TNF alpha inhibitor (TNFAI) therapy has been associated with inflammatory neurological syndromes.Objectives: To present 10 new cases of TNFAI associated neurological disease and a review of the literature.Methods: The design and methods were based on case series collected from Oregon Health & Sciences University and the Department of Veterans Affairs Hospital in Portland, Oregon and PubMed review.Results: We describe eight demyelinating central nervous system syndromes and two peripheral nervous system syndromes associated with TNFAI therapy. Characteristics from these cases are analyzed with data from 141 additional cases from the literature. Onset was between the ages of 36 and 65 years in 84{\%} of CNS cases, distinguishing TNFAI-associated disease from sporadic multiple sclerosis. Symptoms occurred within one year of TNFAI therapy in 71{\%}. Etanercept therapy was reported in the majority of cases of CNS syndromes and infliximab therapy in the majority of neuromuscular syndromes. Significant disability remained in 67{\%} of cases although 82{\%} had been followed for less than one year.Conclusions: Our case series and literature review demonstrates an association between TNFAI therapy and inflammatory neurological disease. While a causal relationship is suggested, this remains uncertain. TNFAI-associated neurological syndromes are associated with significant disability and longer follow-up is needed to better determine natural history and evaluate appropriate treatment interventions.",
keywords = "antagonist, demyelination, inhibitor, multiple sclerosis, neuropathy, optic neuritis, tumor necrosis factor alpha",
author = "Solomon, {Andrew J.} and Rebecca Spain and Kruer, {Michael C.} and Dennis Bourdette",
year = "2011",
doi = "10.1177/1352458511412996",
language = "English (US)",
volume = "17",
pages = "1472--1487",
journal = "Multiple Sclerosis",
issn = "1352-4585",
publisher = "SAGE Publications Ltd",
number = "12",

}

TY - JOUR

T1 - Inflammatory neurological disease in patients treated with tumor necrosis factor alpha inhibitors

AU - Solomon, Andrew J.

AU - Spain, Rebecca

AU - Kruer, Michael C.

AU - Bourdette, Dennis

PY - 2011

Y1 - 2011

N2 - Background: TNF alpha inhibitor (TNFAI) therapy has been associated with inflammatory neurological syndromes.Objectives: To present 10 new cases of TNFAI associated neurological disease and a review of the literature.Methods: The design and methods were based on case series collected from Oregon Health & Sciences University and the Department of Veterans Affairs Hospital in Portland, Oregon and PubMed review.Results: We describe eight demyelinating central nervous system syndromes and two peripheral nervous system syndromes associated with TNFAI therapy. Characteristics from these cases are analyzed with data from 141 additional cases from the literature. Onset was between the ages of 36 and 65 years in 84% of CNS cases, distinguishing TNFAI-associated disease from sporadic multiple sclerosis. Symptoms occurred within one year of TNFAI therapy in 71%. Etanercept therapy was reported in the majority of cases of CNS syndromes and infliximab therapy in the majority of neuromuscular syndromes. Significant disability remained in 67% of cases although 82% had been followed for less than one year.Conclusions: Our case series and literature review demonstrates an association between TNFAI therapy and inflammatory neurological disease. While a causal relationship is suggested, this remains uncertain. TNFAI-associated neurological syndromes are associated with significant disability and longer follow-up is needed to better determine natural history and evaluate appropriate treatment interventions.

AB - Background: TNF alpha inhibitor (TNFAI) therapy has been associated with inflammatory neurological syndromes.Objectives: To present 10 new cases of TNFAI associated neurological disease and a review of the literature.Methods: The design and methods were based on case series collected from Oregon Health & Sciences University and the Department of Veterans Affairs Hospital in Portland, Oregon and PubMed review.Results: We describe eight demyelinating central nervous system syndromes and two peripheral nervous system syndromes associated with TNFAI therapy. Characteristics from these cases are analyzed with data from 141 additional cases from the literature. Onset was between the ages of 36 and 65 years in 84% of CNS cases, distinguishing TNFAI-associated disease from sporadic multiple sclerosis. Symptoms occurred within one year of TNFAI therapy in 71%. Etanercept therapy was reported in the majority of cases of CNS syndromes and infliximab therapy in the majority of neuromuscular syndromes. Significant disability remained in 67% of cases although 82% had been followed for less than one year.Conclusions: Our case series and literature review demonstrates an association between TNFAI therapy and inflammatory neurological disease. While a causal relationship is suggested, this remains uncertain. TNFAI-associated neurological syndromes are associated with significant disability and longer follow-up is needed to better determine natural history and evaluate appropriate treatment interventions.

KW - antagonist

KW - demyelination

KW - inhibitor

KW - multiple sclerosis

KW - neuropathy

KW - optic neuritis

KW - tumor necrosis factor alpha

UR - http://www.scopus.com/inward/record.url?scp=81755172594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81755172594&partnerID=8YFLogxK

U2 - 10.1177/1352458511412996

DO - 10.1177/1352458511412996

M3 - Article

VL - 17

SP - 1472

EP - 1487

JO - Multiple Sclerosis

JF - Multiple Sclerosis

SN - 1352-4585

IS - 12

ER -