Case Report of Transverse Myelitis in a Patient Receiving Etanercept for Rheumatoid Arthritis

Defty, Helen; Sames, Edward; Doherty, Teresa; Hughes, Rodney

doi:10.1155/2013/728371

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…CNS demyelination evolved to multiple sclerosis in two patients (138), with newonset multiple sclerosis in another patient (139). Neuropathy with various presentations (140)(141)(142)(143), myelitis (142,144) and neuritis (142,145,146) are described elsewhere. A case of tumefactive demyelinating lesions is also presented (147).…”

Section: Neurological Adverse Eventsmentioning

confidence: 99%

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Nanau¹,

Neuman

2014

J Pharm Pharm Sci

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Purpose. Inflammatory and rheumatic arthritis remain leading causes of disability worldwide. The arthritis therapeutic area commands the largest market for the prescription of biological and non-steroidal anti-inflammatory drugs (NSAID). Yet biotechnology and pharmaceutical companies conducting research and providing therapeutics in this area frequently face challenges in patient safety. The purpose of our study was to assess safety of anti-tumor necrosis factor therapies in arthritis patients. Methods: The present study systematically reviews adverse events of biologicals alone or in the presence of NSAIDs and other immunosuppressant therapeutics such as disease-modifying antirheumatic drugs (DMARD). We assessed the rheumatology literature that included clinical trials with anti-tumor necrosis factor (TNF) biologicals and case reports published between 2010 and 2014. Results: Currently approved anti-TNF biologicals in arthritis include the monoclonal antibodies infliximab, adalimumab, certolizumab pegol and golimumab, and the fusion protein etanercept. The most frequently-reported adverse event was infection. We grouped the adverse reactions as immune-mediated, hypersensitivity syndrome reactions including cutaneous and hepatic manifestation, neurological, hematological, and malignancy. Discussion: Most adverse events are due to the failure of host immunological control, which involves susceptibility to the drug itself, or de novo infection or reactivation of a latent bacterial or viral infection, often with a different expression of disease. Drug-induced liver injury associated with anti-TNF biologicals must be kept in mind when evaluating patients with increased liver enzymes. Conclusion: Risk assessment in individuals undergoing treatment with biologicals represents a step towards achieving a personalized medicine approach to identify those patients that will safely benefit from this therapeutic approach. Patients and physicians must be alert of anti-TNF agents as potential causes of drug-induced liver injury and monitor the therapies. Personalizing therapeutic pharmacovigilance promises to optimize benefits while minimizing side effects.This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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Section: Neurological Adverse Eventsmentioning

confidence: 99%

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Nanau¹,

Neuman

2014

J Pharm Pharm Sci

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“…The literature regarding TNFI-associated myelitis is currently limited to case reports and small case series. To the best of our knowledge, there are currently 21 reported cases with clinically and radiographically confirmed TNFI-associated myelitis (Supplementary Table 1) (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). The median age of the patients was 52 years with male to female ratio of 1:3.…”

Section: Tnfi-associated Myelitis: Clinical Presentation Diagnostic F...mentioning

confidence: 99%

“…The clinical presentation included paraparesis with sensory and motor deficits in 8 patients, isolated sensory deficits in 9, isolated motor deficits in 2, and unclear in 2 patients. Sphincter involvement was reported in 6 cases (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). MRI of the spine was positive for myelitis in 20 patients and negative in one patient despite a clinical picture that was highly suggestive of myelitis (33).…”

Section: Tnfi-associated Myelitis: Clinical Presentation Diagnostic F...mentioning

confidence: 99%

“…CSF OCB testing was positive in 8/13 cases. MRI brain performed in 20 patients demonstrated signs of demyelination in 7 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). TNFI was discontinued in all patients.…”

Section: Tnfi-associated Myelitis: Clinical Presentation Diagnostic F...mentioning

confidence: 99%

“…Outcomes were reported as complete response in 5 patients, partial response in 11 patients and no response in 5 patients. Notably, all patients with complete response had received IVMP, while in the majority of patients without response TNFI discontinuation was the sole treatment (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Six patients fulfilled clinical and/or radiographic criteria for new-onset MS at the time of presentation with myelitis, in 3 cases with subsequent MS relapses, and one patient developed progressive MS (25,27,35,36).…”

Section: Tnfi-associated Myelitis: Clinical Presentation Diagnostic F...mentioning

confidence: 99%

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Drug-related immune-mediated myelopathies

Gritsch

Valencia‐Sánchez²

2022

Front. Neurol.

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Iatrogenic immune-mediated inflammatory disorders of the spinal cord are an uncommon but potentially severe complication of drug therapy for several human diseases. Particularly the introduction of novel biological agents in the treatment of systemic inflammatory disorders and cancer immunotherapy have led to a significant increase in immune-related adverse events of the central nervous system (CNS). The use of Tumor necrosis factor alpha (TNF-alpha) inhibitors in rheumatic and inflammatory bowel diseases has been associated with demyelinating and other inflammatory CNS conditions, including myelitis. The introduction of immune checkpoint inhibitors in the treatment of several human malignancies has led to an increase in drug-induced immune-related adverse events including in the CNS. Other drugs that have been associated with immune-mediated myelitis include tyrosine-kinase inhibitors and chimeric antigen receptor (CAR) T Cell therapy. A high degree of suspicion is necessary when diagnosing these conditions, as early diagnosis and treatment is crucial in preventing further neurological damage and disability. The treatment of drug-induced inflammatory myelitis typically involves administration of high-dose intravenous corticosteroids, however additional immunosuppressive agents may be required in severe or refractory cases. While most cases are monophasic and remit following discontinuation of the offending agent, chronic immunosuppressive therapy may be indicated in cases with a progressive or relapsing disease course or when a diagnosis of a specific underlying neuro-inflammatory disorder is made. Outcomes are generally favorable, however depend on the specific therapeutic agent used, the clinical presentation and patient factors. In this review we aim to describe the clinical characteristics, imaging findings and management for the most common forms of iatrogenic immune-mediated myelopathies.

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CNS Demyelination with TNF-α Blockers

Kemanetzoglou

Andreadou

2017

Curr Neurol Neurosci Rep

254

200

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Tumor necrosis factor–α (TNF-α) blockers are a popular therapeutic choice in a number of inflammatory diseases. Thus far, five TNF- α blockers have been approved for clinical use (etanercept, infliximab, adalimumab, golimumab. and certolizumab). Despite being considered relatively safe, serious side effects associated with immune suppression have been reported, including central and peripheral nervous system (CNS) demyelinating disorders. It is still elusive whether these events are mere coincidence or a side effect of anti-TNF-α use. In this paper, we review the published case reports of CNS demyelination associated with anti-TNF-α therapy and present the follow-up of our 4 previously reported patients who developed neurologic symptoms suggestive of CNS demyelination after having received anti-TNF-α treatment. We also discuss the possible role of TNF-α blockers in demyelination.

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Case Report of Transverse Myelitis in a Patient Receiving Etanercept for Rheumatoid Arthritis

Cited by 5 publications

References 7 publications

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Drug-related immune-mediated myelopathies

CNS Demyelination with TNF-α Blockers

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