Demyelinating Disease is a Rare Complication of TNF Inhibition. Save

A recent review has shown that tumor necrosis factor-α inhibitors (TNFi) rarely cause MS-like disorders. Although the Food and Drug Administration warnings on the label of all TNFis state "rare cases of new onset or exacerbation of central nervous system demyelinating disorders", the true incidence is not known.

In a study of published clinical trials, the frequency of reported multiple sclerosis was:

• 1/ 6990 patients on etanercept developed multiple sclerosis
• 0/ 5204 patients treated with adalimumab
• 1/ 2322 patients were treated with infliximab had a demyelinating polyneuropathy
• Outside of clinical trials: 19 individual cases of demyelinating disorders from TNFi treatment have been reported.

This review suggest that although there are reports of neurologic complications with TNF blockade, demyelinating disorders are extremely rare.

It is also unknown from these reports or the literature if it is safe to give TNFi to patients with a history of demyelinating disease (e.g., optic neuritis, multiple sclerosis).