Anti-TNF alpha-Induced Neuropathies (P7.091)

OBJECTIVE: Our aim was to determine the type and frequency of peripheral neuropathy in a population of patients with inflammatory disorders (ID) taking anti-TNF alpha agents. BACKGROUND: Anti-TNF alpha-induced neuropathies may occur during initial or maintenance treatment with anti-TNF alpha agents in ID patients. DESIGN/METHODS: We retrospectively ascertained neuropathy in a cohort of patients having in common ID, use of anti-TNF alpha agents, and peripheral neuropathy in our tertiary university hospital between 2000 and 2012, using our medical records archiving system. RESULTS: We identified 10 patients among 19,500 EMG exams over 13 years corresponding to inclusion criteria; and systematically reviewed the clinical features, laboratory studies, neurophysiological findings, and histopathological changes. Among the patients, 6 were males, 4 had bowel ID and 6 arthritis. Five had a focal or multifocal peripheral neuropathy : one had erythromelalgia at the tips of the digits of her left hand; two had a non-compressive, inflammatory, radiculopathy; two had neuropathy with persistent conduction block (one localized proximally on the femoral nerve, the other at the peroneal head). Five patients developed a generalized, non length-dependent, neuropathy : two had a sensory variant of GBS; one a Lewis-Sumner syndrome; one a CIDP-like neuropathy; another a motor type of Guillain-Barre syndrome. All patients improved following discontinuation of anti-TNF alpha agents and introduction of immunomodulatory or immunosuppressant agents, except for the CIDP like neuropathy that eventually revealed a CMT neuropathy. CONCLUSIONS: Our rare anti-TNF alpha-induced neuropathies were surprisingly heterogeneous in their clinical manifestations (onset, pattern, type) and were seen during initial or maintenance therapy periods. No true peripheral nerve toxicity (i.e., dependent on cumulative dose) was identified. Early recognition of these neuropathies has management (targeted immunotherapy) and prognostic (mostly favorable) implications. Disclosure: Dr. Tsouni has nothing to disclose. Dr. Bill has nothing to disclose. Dr. Benninger has nothing to disclose. Dr. Ochsner has nothing to disclose. Dr. Kuntzer has nothing to disclose.