MS Arising During Tocilizumab Therapy for Rheumatoid Arthritis (P3.014)

Objective: To describe a case of a patient who develop MS using IL-6 receptor antagonist Tocilizumab. Background: Interleukin-6 (IL-6) blockage is a treatment strategy used in many inflammatory conditions. Trials in Neuromyelitis Optica Spectrum Disorder (NMOSD) are ongoing. Secondary auto-immunity affecting the CNS is well described with some biologic agents, mainly TNF-alpha inhibitors. These treatments can also aggravate patients with known Multiple Sclerosis (MS). Methods: Brain MRI was performed at presentation and controlled 3 months later. It showed both dissemination in time and in space. Results: A 48-years old woman develops MS while on treatment with Tocilizumab for Rheumatoid Arthritis (RA). This is the first published report of this association. It has obvious implications for NMOSD patients receiving anti-IL6 therapy. Development of new white matter lesions suggestive of MS in a patient treated with anti-IL6 therapy might represent an important complication of therapy. Conclusions: This case illustrates that Tocilizumab might cause secondary auto-immunity in CNS. It is important to be aware of this potential complication as anti-IL6 therapy might become an option for the treatment NMOSD. Disclosure: Dr. Beauchemin has nothing to disclose. Dr. Robert L. Carruthers has received personal compensation for activities with Genzyme as an consultant.