Neurological Complications of Anti-TNF Agents Are Rare, but Most Common With Infliximab

Anti—tumor necrosis factor (anti-TNF) agents, widely used in rheumatology and gastroenterology, carry some safety risks. While the risk of infection or malignancy are common concerns, neurological complications, while rare, are also possible.

During the fourth congress of the European Academy of Neurology, held in Lisbon, Portugal, from June 16 to 19, researchers reported on neurological complications with anti-TNF drugs in their 16 years of experience in a tertiary university hospital in Madrid, Spain.

The researchers performed a retrospective analysis of their center’s neurology department from 2002 to 2007 and identified patients who had received the anti-TNF agents infliximab, etanercept, adalimumab, and golimumab. They included in their analysis patients who had neurological issues while actively being treated with any of these agents.

In total, there were 15 episodes of neurological complications in 14 patients who were receiving treatment with infliximab, adalimumab, or golimumab to treat inflammatory bowel disease, rheumatoid arthritis, spondyloarthropathy, psoriatic arthritis, or pyoderma gangrenosum. No patients being treated with etanercept reported neurological complications.

Nine of the patients who had complications were treated with infliximab, 6 were treated with adalimumab, and 1 was treated with golimumab.

In total:

• 9 patients had a transient ischemic attack or stroke
• 3 patients had demyelinating central nervous system disease
• 1 patient had cerebral venous thrombosis
• 3 patients had other neurological diagnoses
• In 2 cases of stroke, 1 case of psychogenic neurological symptoms, and 1 case of headache, anti-TNF agents were deemed not to be the cause of complication
• In 4 cases, patients discontinued anti-TNF treatment due to neurological complaints

The authors write that, in their experience, neurological complications of anti-TNF therapies are rare, but that they are most commonly reported with infliximab, and stroke is the most commonly reported complication; “A possible association with stroke of undetermined etiology should be assessed with prospective studies,” say the researchers.

Reference

Gomez A, Nater E, Monreal S, et al. Neurological complications of antiTNF therapies: 16 years of tertiary university hospital experience. Presented at the European Academy of Neurology Congress, June 16-19, 2018; Lisbon, Portugal. Abstract EPR1130. https://ipp-ean18.netkey.at/index.php?p=recorddetail&rid=2dec48c7-efbe-4a30-aa16-a7c040870eb3&t=browsepresentations.