Leukoencephalopathy during administration of etanercept for refractory rheumatoid arthritis

Abstract

A 74-year-old Japanese woman was diagnosed with rheumatoid arthritis due to polyarthralgia. She was prescribed various disease-modifying anti-rheumatic drugs, but most of them were discontinued because of side effects or poor effectiveness. She was referred to our hospital in 2004, and etanercept was administered from June 2005. This resulted in rapid improvement of polyarthritis; however, she developed disorientation from February 2006. She was admitted to our hospital because of convulsions and loss of consciousness. She was diagnosed with progressive multifocal leukoencephalopathy on the basis of clinical symptoms and magnetic resonance imaging of the brain. In this significant and important case, leukoencephalopathy occurred during etanercept administration, and we refer to the risk of anti-TNFalpha drugs.

A systematic review and economic evaluation of the use of tumour necrosis factor-alpha (TNF-α) inhibitors, adalimumab and infliximab, for Crohn’s disease

“…The single instance associated with anti-TNF treatment was reported for a 74-year-old woman given etanercept for rheumatoid arthritis. 83 …”

TNF-antagonist etanercept induced reversible posterior leukoencephalopathy syndrome

“…Side effects have been mostly dermatologic (psoriasis) and infectious complications (tuberculosis, legionellosis). Recently a case of progressive multifocal leukoencephalopathy (PML) as an infectious complication under etanercept [11] and an association with Guillain-Barré syndrome have been reported [8]. It also seems likely that TNF antagonists can trigger bouts of demyelinating disorders like optic neuritis [9].…”

Targeted Therapy and Infections in Rheumatic Diseases

“…В начале 2014 г. Федеральная служба по надзору в сфе-ре здравоохранения Российской Федерации опубликовала письмо с сообщением о 2 случаях ПМЛ у пациентов с СКВ, получавших лечение БЛМ в пострегистрационном периоде [114]. Опубликованы сообщения о возникновении ПМЛ при лечении РА ИНФ, ЭТЦ, АДА и ТЦЗ [115][116][117][118]. Основные клинические симптомы ПМЛ -головная боль, прогрессиру-ющая деменция, речевые нарушения, атаксия, гиперкинезы, расстройства чувствительности, гемипарезы, признаки пора-жения черепных нервов.…”