TNF-Alpha Antagonists and Neurologic Side Effects: A Literature Review

Although several tumor necrosis factor-alpha antagonists (TNF-α therapy) have been approved by the FDA for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis, dermatologists had concerns regarding their potential for the rare induction or exacerbation of demyelinating processes. Whether TNF-α therapy induces new-onset demyelination or exacerbates pre-existing latent multiple sclerosis is not fully understood. TNF-α antagonists are immunosuppressive agents used to treat various chronic inflammatory diseases, including rheumatoid arthritis (RA), Crohn's disease, ankylosing spondylitis (AS), psoriasis, and psoriatic arthritis. Demyelinating symptoms have been observed in many of the diseases for which TNF-α therapy is approved. In addition, neurological disorders have been reported during treatment with all TNF-α antagonists, most commonly etanercept. Based on the data, it seems most reasonable to exercise caution in patients with established demyelinating disease and to immediately discontinue therapy and pursue diagnostic tests in any patient with suspected demyelination.