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Long-term Course of Demyelinating Neuropathies Occurring During Tumor Necrosis Factor-–Blocker Therapy

Pierre Lozeron, MD; Christian Denier, MD, PhD; Catherine Lacroix, MD; David Adams, MD, PhD

Arch Neurol. 2009;66(4):490-497.

Objective  To report the long-term follow-up (mean, 41 months; range, 25-55 months) of patients with demyelinating neuropathy occurring after tumor necrosis factor- (TNF-) blocker treatment (infliximab [Remicade], etanercept [Enbrel], and adalimumab [Humira]).

Background  Demyelinating neuropathy is a rare adverse event of anti–TNF- therapy. Improvement usually occurs after drug interruption and/or in association with usual treatments for demyelinating neuropathies.

Design  Case report with review of the previously published cases.

Setting  University hospital in Le Kremlin-Bicêtre, France: tertiary reference center for peripheral neuropathies and national reference center for rare peripheral neuropathies (www.nnerf.fr).

Patients  Five patients (4 men, mean age, 47 years) who developed a demyelinating neuropathy during anti–TNF- therapy.

Main Outcome Measure  Development of neuropathy.

Results  Neuropathy developed early (8 months) after treatment introduction. Various clinical patterns were encountered, including pure sensory neuropathy. Immunomodulating treatments were always required for neuropathy control. Chronic demyelinating neuropathy developed either after change of anti–TNF- drug or spontaneously after treatment discontinuation without any drug reintroduction.

Conclusion  Influence of anti–TNF- treatment continuation on the long-term course of neuropathy is variable, suggesting that anti–TNF- treatment withdrawal is not always necessary for neuropathy control.

Author Affiliations: Departments of Neurology (Drs Lozeron, Denier, Lacroix, and Adams) and Neuropathology (Dr Lacroix), Assistance Publique–Hôpitaux de Paris, Université Paris Sud, and National Reference Centre of Familial Amyloid Polyneuropathy and Other Rare Peripheral Neuropathies (Drs Lozeron, Denier, Lacroix, and Adams), Le Kremlin-Bicêtre, France.

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