PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders
Since their introduction in 1999, anti-tumour necrosis factor-α (anti-TNF-α) therapies have been suspected repeatedly to be associated with the occurrence of central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS). However, recent publications were restricted to descr...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
SAGE Publishing
2020-01-01
|
Series: | Therapeutic Advances in Neurological Disorders |
Online Access: | https://doi.org/10.1177/1756286419895155 |
id |
doaj-2619c31f940d49b3a6d2e7f4849974a1 |
---|---|
record_format |
Article |
spelling |
doaj-2619c31f940d49b3a6d2e7f4849974a12020-11-25T03:38:27ZengSAGE PublishingTherapeutic Advances in Neurological Disorders1756-28642020-01-011310.1177/1756286419895155PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disordersSinah EngelFelix LuessiAneka MuellerRudolf E. SchopfFrauke ZippStefan BittnerSince their introduction in 1999, anti-tumour necrosis factor-α (anti-TNF-α) therapies have been suspected repeatedly to be associated with the occurrence of central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS). However, recent publications were restricted to descriptions of monophasic demyelinating events or cases of relapsing–remitting MS (RRMS). We here provide the first case report of primary progressive MS (PPMS) onset upon anti-TNF-α therapy as well as a literature review of previously published cases of anti-TNF-α therapy-associated MS onset. The 51-year old male patient was treated with adalimumab due to psoriasis arthritis. About 18 months after treatment initiation, he developed slowly progressing neurological deficits including gait impairment, paraesthesia of the lower limbs, strangury and visual impairment, which led to the discontinuation of adalimumab therapy. Magnetic resonance imaging of the brain and the spinal cord revealed multiple inflammatory lesions and cerebrospinal fluid examination showed slight pleocytosis and positive oligoclonal bands. Thus, PPMS was diagnosed according to the 2017 revision of the McDonald criteria. As PPMS often causes only subtle symptoms in the beginning and early treatment discontinuation of anti-TNF-α therapy seems essential to improve the patient’s outcome, we think that it is important to increase the awareness of slowly progressing neurological deficits as a potential adverse event of anti-TNF-α therapy among all clinicians involved in the initiation and monitoring of these drugs. In addition, the occurrence of both RRMS and progressive MS upon anti-TNF-α therapy might suggest a shared TNF-α-mediated pathophysiological mechanism in the evolution of all MS subtypes.https://doi.org/10.1177/1756286419895155 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sinah Engel Felix Luessi Aneka Mueller Rudolf E. Schopf Frauke Zipp Stefan Bittner |
spellingShingle |
Sinah Engel Felix Luessi Aneka Mueller Rudolf E. Schopf Frauke Zipp Stefan Bittner PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders Therapeutic Advances in Neurological Disorders |
author_facet |
Sinah Engel Felix Luessi Aneka Mueller Rudolf E. Schopf Frauke Zipp Stefan Bittner |
author_sort |
Sinah Engel |
title |
PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders |
title_short |
PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders |
title_full |
PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders |
title_fullStr |
PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders |
title_full_unstemmed |
PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders |
title_sort |
ppms onset upon adalimumab treatment extends the spectrum of anti-tnf-α therapy-associated demyelinating disorders |
publisher |
SAGE Publishing |
series |
Therapeutic Advances in Neurological Disorders |
issn |
1756-2864 |
publishDate |
2020-01-01 |
description |
Since their introduction in 1999, anti-tumour necrosis factor-α (anti-TNF-α) therapies have been suspected repeatedly to be associated with the occurrence of central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS). However, recent publications were restricted to descriptions of monophasic demyelinating events or cases of relapsing–remitting MS (RRMS). We here provide the first case report of primary progressive MS (PPMS) onset upon anti-TNF-α therapy as well as a literature review of previously published cases of anti-TNF-α therapy-associated MS onset. The 51-year old male patient was treated with adalimumab due to psoriasis arthritis. About 18 months after treatment initiation, he developed slowly progressing neurological deficits including gait impairment, paraesthesia of the lower limbs, strangury and visual impairment, which led to the discontinuation of adalimumab therapy. Magnetic resonance imaging of the brain and the spinal cord revealed multiple inflammatory lesions and cerebrospinal fluid examination showed slight pleocytosis and positive oligoclonal bands. Thus, PPMS was diagnosed according to the 2017 revision of the McDonald criteria. As PPMS often causes only subtle symptoms in the beginning and early treatment discontinuation of anti-TNF-α therapy seems essential to improve the patient’s outcome, we think that it is important to increase the awareness of slowly progressing neurological deficits as a potential adverse event of anti-TNF-α therapy among all clinicians involved in the initiation and monitoring of these drugs. In addition, the occurrence of both RRMS and progressive MS upon anti-TNF-α therapy might suggest a shared TNF-α-mediated pathophysiological mechanism in the evolution of all MS subtypes. |
url |
https://doi.org/10.1177/1756286419895155 |
work_keys_str_mv |
AT sinahengel ppmsonsetuponadalimumabtreatmentextendsthespectrumofantitnfatherapyassociateddemyelinatingdisorders AT felixluessi ppmsonsetuponadalimumabtreatmentextendsthespectrumofantitnfatherapyassociateddemyelinatingdisorders AT anekamueller ppmsonsetuponadalimumabtreatmentextendsthespectrumofantitnfatherapyassociateddemyelinatingdisorders AT rudolfeschopf ppmsonsetuponadalimumabtreatmentextendsthespectrumofantitnfatherapyassociateddemyelinatingdisorders AT fraukezipp ppmsonsetuponadalimumabtreatmentextendsthespectrumofantitnfatherapyassociateddemyelinatingdisorders AT stefanbittner ppmsonsetuponadalimumabtreatmentextendsthespectrumofantitnfatherapyassociateddemyelinatingdisorders |
_version_ |
1724542263811375104 |