Tumor necrosis factor-alpha antagonist and demielynating diseases

Anti-TNF treatment –associated disorders have emerged as a new class of drugrelated demielynating neurological disease. Neurological deficits that develop during treatment with TNF-alfa antagonists are relatively rare (the prevalence of demielynating disease, as reported in randomized controlled trials and postmarketing studies, has been estimated to range from 0,02-0,2%) but important potential complications of these drugs. Most of the patients described in the literature had no personal or family history of Multiple Sclerosis. These disorders include, among others, multiple sclerosis, optic neuritis, and various forms of peripheral demyelinating neuropathy. Short-term follow-up indicates relatively good outcomes, sometimes after just treatment discontinuation, although corticosteroids or intravenous immunoglobulin may be necessary to reverse and stabilize these disorders. Definitive cessation of the biological therapy should be discussed on a case-by-case basis