Demyelinating neuropathies are rare adverse events of anti–TNF-alpha therapy. Previous series emphasized the development of acute or chronic demyelinating neuropathy usually occurring a few months after the onset of TNFalpha- treatment, very often associated with conduction blocks on nerve conduction studies. The prognosis is usually good, without relapse, sometimes only after usual treatments for demyelinating neuropathies.

In de studie naar de effecten van 5 patienten die met deze stoffen behandeld werden en die een ernstige neuropathie ontwikkelden, vatten de auteurs hun inzichten als volgt samen:

Our data tend to show that once anti–TNF-blockers have triggered a demyelinating neuropathy, the ensuing course of the neuropathy is unpredictable, with or without drug interruption. Spontaneous relapse can occur without anti-TNF treatment reintroduction, and on the contrary, 1 of the 2 patients who pursued anti–TNF-alpha treatment stabilized with minimal residual symptoms after drug dosage reduction.

This is of critical importance in many patients who benefit from anti–TNF-alpha treatment for their underlying disease. Drug interruption should probably be limited to patients with ongoing disabling neuropathies and controlled underlying affections. Furthermore, efficacy of usual treatments for demyelinating neuropathies indicates that the management and monitoring of these patients should be similar to that for idiopathic demyelinating neuropathies and should be undertaken under the supervision of a neurologist. ^[1]

Versie oktober 2009; Auteurs: Prof.dr. Jan M. Keppel Hesselink, en Drs. David J. Kopsky, artsen   

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