Fatal Central Nervous System Disease Following First Infliximab Infusion in a Child With Inflammatory Bowel Disease

Bäumer, F; Ouahed, Jodie; Verhave, Menno; Rivkin, Michael J.

doi:10.1016/j.pediatrneurol.2015.12.017

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…This neurological involvement is often related either to a dysimmune mechanism or to a prothrombotic state [4,5]. However, multiple sclerosis (MS) and optic neuritis remain the most common inflammatory demyelinating diseases of the central nervous system (CNS) associated with IBD [1,6,7].…”

Section: Discussionmentioning

confidence: 99%

Chronic Inflammatory Bowel Disease and Demyelination of the Central Nervous System: A Report on Two Cases

Oumerzouk¹,

Klevor²,

Chraa³

et al. 2022

RNA Viruses Infection

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The objective of this article is to investigate the link between chronic inflammatory bowel disease (IBD) and central nervous system (CNS) demyelination. CNS demyelinating disorders in IBD are rare complications and are due to a dysimmune mechanism. We report the clinical cases of two patients followed for IBD. The first patient had Crohn’s disease for 12 years and developed acute disseminated encephalomyelitis (ADEM) 1 month after the first course of the anti-tumor necrosis factor alpha (anti-TNF-alpha), infliximab. The second patient, treated for ulcerative colitis with salazopyrin, developed multiple sclerosis (MS) 5 months after the start of her disease. MS and optic neuritis remain the inflammatory demyelinating diseases of the CNS most frequently associated with IBD. The activation of T lymphocytes during IBD plays an essential role in the pathogenesis of MS and ADEM in a genetically predisposed population. It is currently recommended that patients with IBD be evaluated clinically and by MRI for subclinical demyelinating lesions in order to guide therapeutic management.

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Section: Discussionmentioning

confidence: 99%

Chronic Inflammatory Bowel Disease and Demyelination of the Central Nervous System: A Report on Two Cases

Oumerzouk¹,

Klevor²,

Chraa³

et al. 2022

RNA Viruses Infection

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“…Others NAEs include seizures in posterior reversible encephalopathy syndrome (as described in patient 6), which improved after anti-TNFa antibody discontinuation (8,(16)(17)(18), progressive multifocal leukoencephalopathy, CNS infections, and vasculitis with CNS involvement (5,8). Strokes have been described after the first IFX infusion (20), but the FDAERS has not found a statistically increased risk (14), and in meta-analysis risk of stroke is modestly increased in IBD: for patient 7, the association of aneurism, IBD, and IFX has probably favorized the development of cerebral thrombosis (46). In addition, our study describes the first case of sensorineural hearing loss under anti-TNFa-antibodies in a child with IBD, but it has already been reported as extraintestinal manifestation of IBD (47).…”

Section: Discussionmentioning

confidence: 99%

“…So far, only 8 cases of NAE under anti-TNFa antibodies are reported in children with IBD: 3 cases of posterior reversible encephalopathy, 1 multifocal leukoencephalopathy, 1 ischemic fatal central nervous system (CNS) disease, 1 small fiber neuropathy, 1 meningitis, and 1 medulloblastoma (16)(17)(18)(19)(20)(21)(22). Moderate NAE such as headaches are also reported during infusions (23,24).…”

mentioning

confidence: 99%

Neurological Adverse Effects Associated With Anti‐tumor Necrosis Factor Alpha Antibodies in Pediatric Inflammatory Bowel Diseases

Bertrand¹,

Massy

Pigneur

et al. 2020

J. pediatr. gastroenterol. nutr.

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Objectives: Neurological adverse effects (NAEs) induced by biotherapies have been reported in the literature mainly in adult patients with inflammatory bowel disease (IBD), rheumatic diseases, or psoriasis. There are scant data in children. Aims of this study are to report and describe noninfective NAE associated with anti-TNFα antibodies in pediatric IBD, and to evaluate their incidence. Methods: We retrospectively collected all reports of NAE in pediatric IBD treated with anti-TNFα antibodies recorded in the French Pharmacovigilance Database. To estimate the national incidence of NAEs, we extrapolated data from the French regional inception population-based cohort EPIMAD. Results: Between 2000 and 2018, 231 adverse events in pediatric IBD exposed to anti-TNFα antibodies were reported to this Database. Seventeen NAEs (7.36%) were collected: 8 severe NAE (1 demyelinating neuropathy, 1 optic neuritis, 1 acute transverse myelitis, 1 polyradiculoneuritis, 1 sensorineural hearing loss, 1 seizure, 1 stroke, and 1 glioma), 7 moderate NAE (headaches), and 2 neuropsychic events. The median delay between anti-TNFα start and NAE occurrence was 6 months (range: 13 days to 26 months). In 10 of 17 patients, anti-TNFα antibodies were stopped. Nine of 17 patients had a complete resolution (including 2 severe NAE) and 8 of 17 a partial resolution (including 6 severe NAE). We estimate the incidence of severe NAE in pediatric IBD treated with anti-TNFα antibodies at 1 case for 10,000 patients-year in France. Conclusions: NAE associated with anti-TNFα antibodies in pediatric IBD are rare. In severe NAE, we recommend to discontinue anti-TNFα therapy and to consider alternative treatment.

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“…There were fourteen cases of worsening neurological disease despite cessation of anti-TNF therapy and several reports of new, clinically silent lesions detected on follow-up imaging. 202,[205][206][207][208][209][210][211][212][213][214][215][216] A case-control study in rheumatoid arthritis using a Canadian administrative claims and electronic medical records database showed a trend towards an increased rate of demyelination in 891 patients with no risk factors (for demyelination) with the authors suggesting that TNF antagonist therapy may increase risk of truly incident demyelinating events by ~30%, although failed to meet statistical significance (adjusted rate ratio 1.31 [95% CI 0.68-2.50]). 217 To date, trial and pharmacovigilance registry data have not shown any increased risk although this may relate to a low overall incidence, as well as exclusion of people at particular risk.…”

Section: Expert Consensusmentioning

confidence: 99%

EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 2: specific clinical and comorbid situations

Nast

Smith

Spuls

et al. 2021

Acad Dermatol Venereol

108

141

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This evidence‐ and consensus‐based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The second part of the guideline provides guidance for specific clinical and comorbid situations such as treating psoriasis vulgaris patient with concomitant psoriatic arthritis, concomitant inflammatory bowel disease, a history of malignancies or a history of depression or suicidal ideation. It further holds recommendations for concomitant diabetes, viral hepatitis, disease affecting the heart or the kidneys as well as concomitant neurological disease. Advice on how to screen for tuberculosis and recommendations on how to manage patients with a positive tuberculosis test result are given. It further covers treatment for pregnant women or patients with a wish for a child in the near future. Information on vaccination, immunogenicity and systemic treatment during the COVID‐19 pandemic is also provided.

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Fatal Central Nervous System Disease Following First Infliximab Infusion in a Child With Inflammatory Bowel Disease

Cited by 7 publications

References 17 publications

Chronic Inflammatory Bowel Disease and Demyelination of the Central Nervous System: A Report on Two Cases

Chronic Inflammatory Bowel Disease and Demyelination of the Central Nervous System: A Report on Two Cases

Neurological Adverse Effects Associated With Anti‐tumor Necrosis Factor Alpha Antibodies in Pediatric Inflammatory Bowel Diseases

EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 2: specific clinical and comorbid situations

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