Abstract Details

Title The Spectrum of Inflammatory CNS Disorders Occurring During TNF-alpha Inhibitory Therapy

Topic Autoimmune Neurology

Presentation(s) S11 - Autoimmune CNS Inflammatory Disorders: Clinical Advances (3:41 PM-3:52 PM)

Poster/Presentation
Number 002

Background

TNFαIs are FDA-approved for the treatment of several connective tissue diseases and inflammatory bowel disease (IBD). In our experience, the spectrum of CNS inflammation appears broader than demyelination.

Objective

To systematically evaluate CNS inflammation occurring during TNF-alpha inhibitor (TNFαI) therapy

Design/Methods

Medical records of 153 adults were reviewed (out of an initial search of 13214 patients, 2008-2018). All had: 1) ≥1 connective tissue disease or IBD diagnoses; 2) evaluated in the Department of Neurology, Mayo Clinic, Rochester, Minnesota for a CNS inflammatory disorder (optic neuritis, meningitis, encephalopathy, encephalitis, myelitis, MS, demyelinating disease, sarcoidosis, granulomatous disease); 3) had ≥1 TNFαI listed as active medications within 3 months of neurological evaluation. At record review, 23 patients had an inflammatory CNS diagnosis with neurological symptom onset during TNFαI therapy. Patients with non-inflammatory causes or uncertain diagnoses were excluded.

Results Of 23 included patients, 14 were female. Median neurological symptom-onset age was 57 years (range, 18-73). FDA-approved indications (≥1) were: rheumatoid arthritis (8), Crohn’s disease (6), psoriatic arthritis (5), psoriasis (4), ulcerative colitis (2), ankylosing spondylitis (1). The median duration from most recent TNFαI therapy initiation to onset of neurological symptoms was 4.1 years (range, 1 month-16.9 years. The following TNFαIs were being utilized at neurological symptom onset: adalimumab (11), entanercept (7), infliximab (4), certolizumab (1). Neurological diagnoses were: demyelinating disease, 11 (relapsing remitting multiple sclerosis [6], clinically isolated syndrome [5]), meningitis, 6 (granulomatous lepto- and pachy-meningitis [2], necrotising lepto- and pachymeningitis [1], aseptic meningitis not otherwise specificed [NOS], 3), meningoencephalitis, 4 (granulomatous [2], chronic inflammation NOS [2]), unilateral monophasic optic neuritis, 2.

Conclusions Under half of our patients with inflammatory CNS disorders that developed during TNFαI therapy had demyelinating disease. Inflammatory meningitis or meningoencephalitis were almost as common. Because CNS inflammation might occur as natural history of connective tissue and IBD, a case-control study is planned.

Authors/Disclosures
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre) PRESENTER	Dr. Kunchok has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Journal . Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology:Open Access Journal .
Andrew McKeon, MD (Mayo Clinic)	The institution of Dr. McKeon has received research support from National Institutes of Health. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received publishing royalties from a publication relating to health care.

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