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. 2017 Apr;17(4):36.
doi: 10.1007/s11910-017-0742-1.

CNS Demyelination With TNF-α Blockers

Free PMC article

CNS Demyelination With TNF-α Blockers

Elissavet Kemanetzoglou et al. Curr Neurol Neurosci Rep. .
Free PMC article


Tumor necrosis factor-α (TNF-α) blockers are a popular therapeutic choice in a number of inflammatory diseases. Thus far, five TNF- α blockers have been approved for clinical use (etanercept, infliximab, adalimumab, golimumab. and certolizumab). Despite being considered relatively safe, serious side effects associated with immune suppression have been reported, including central and peripheral nervous system (CNS) demyelinating disorders. It is still elusive whether these events are mere coincidence or a side effect of anti-TNF-α use. In this paper, we review the published case reports of CNS demyelination associated with anti-TNF-α therapy and present the follow-up of our 4 previously reported patients who developed neurologic symptoms suggestive of CNS demyelination after having received anti-TNF-α treatment. We also discuss the possible role of TNF-α blockers in demyelination.

Keywords: Anti-TNF-α; Demyelination; Multiple sclerosis; Tumor necrosis factor.

Conflict of interest statement

Conflict of Interest

Elissavet Kemanetzoglou and Elisabeth Andreadou declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Fig. 1
Fig. 1
(a) and (b): axial T2-weighted cervical spine MRI of the index case 1, treated with ETN for 8 months for PsA, who was diagnosed with MS on follow-up. (a) At initial presentation, a central posterior demyelinating lesion on C3 level that showed gadolinium enhancement on T1-sequences (not shown). (b) Four years after etanecept discontinuation, disappearance of the lesion. (c)(f) Brain and cervical spine MRI of the index case 2, with AS and a family history of MS, treated with adalimumab for 36 months, who was also diagnosed with MS. (c) Brain flair and (d) cervical spine T2-weighted sagittal MRI at symptom onset, and (e)(f) 4 years after anti-TNF-a cessation. Note the increase of cerebral demyelinating lesions, with marked atrophy, and the disappearance of the lesion on C7 level

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