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Background: With the increasing use of biological treatment in inflammatory rheumatic diseases, some neurological side effects, especially central and peripheral nervous system demyelinating disorders, are seen.
Objectives: To evaluate whether there is an increase in the frequency of neurological disorders with biological treatment compared to the normal population, and the relationship between discontinuation of biological agents and neurological symptoms.
Methods: Adult patients using biological treatment followed in the Rheumatology outpatient clinic of Dokuz Eylul University between January 2011 and January 2020 were included. The relationship between biological agents and type, severity and duration of neurological symptoms, and the laboratory, imaging (cranial CT, MRI) and electrophysiological findings of the patients were retrospectively reviewed. Current treatments for rheumatologic disease and neurological findings, and disease activity were investigated.
Results: In our study, neurological side effects were observed in 16 (1.8%) of 877 patients using biological drugs. The mean age of the patients was 51.8±12.53 years, and the duration of rheumatologic disease was 10.69±4.86 years. Nine patients had peripheral neuropathy, two had CNS demyelinating disease, two had peripheral demyelinating disease, two had intracranial mass and one had headache syndrome. The neurological disease developed a mean of 51.31±44.26 months after the first biological agents. The demographic and clinical characteristics of the patients and the neurological side effects that developed during the follow-up period are summarized in
Demographic and clinical characteristics of patients who developed neurological symptoms with biological treatment
| n=16 (%) | ||
|---|---|---|
| Gender | Male | 8 (50) |
| Age of diagnosis (years)¶ | 41,13±12,02 | |
| Disease duration (years)¶ | 10,7±4,86 | |
| Smoking | active | 7 (43,8) |
| exmoker | 2 (12,5) | |
| CRP (mg/L)¶ | 5,03±6,28 | |
| bDMARD | Adalimumab | 5 (31,3) |
| İnfliximab | 4 (25,0) | |
| Etanercept | 2 (12,5) | |
| Certolizumab | 1 (6,3) | |
| Tocilizumab | 1 (6,3) | |
| Secukinumab | 2 (12,5) | |
| Tofacitinib | 1 (6,3) | |
| Imaging (CT, MRI) | Presence of pathological findings | 5 (31,3) |
| Electrophysiological study | Presence of pathological findings | 8 (50,0) |
| Neurological Side Effect | Diabetic Amyotrophy | 1 (6,3) |
| Foot drop | 1 (6,3) | |
| Grade 2 astrocytoma | 1 (6,3) | |
| Meningioma | 1 (6,3) | |
| Cauda equina syndrome | 1 (6,3) | |
| Cubital Tunnel Syndrome | 1 (6,3) | |
| Multiple sclerosis (de nova) | 1 (6,3) | |
| Multiple sclerosis attack | 1 (6,3) | |
| Myasthenia gravis attack | 1 (6,3) | |
| Radicular neuropathy | 1(6,3) | |
| Sensorimotor polyneuropathy | 1 (6,3) | |
| Sensory neuropathy | 1 (6,3) | |
| Pseudotumor cerebri worsening | 1(6,3) | |
| Facial paralysis | 1 (6,3) | |
| CIDP progression | 1(6,3) | |
| Guillain Barre Syndrome | 1 (6,3) | |
| Time to development of adverse events after last bDMARD¶ | 26,37±29,58 | |
| Time after neurological adverse event (months)¶ | 23,75±20,86 | |
| bDMARD continuation status after adverse events | bDMARD discontinuation | 11 (68,8) |
| Neurological symptoms at last visit | Stable | 6 (37,5) |
| Improvement | 9 (56,3) | |
| Progression | 1(6,3) | |
¶ mean±SD
. CIDP:Chronic inflammatory demyelinating polyneuropathy
Conclusion: In this study, the prevalence of neurological diseases such as brain tumors, multiple sclerosis, and myasthenia gravis increased in patients receiving biological treatment compared to the normal population. Therefore, patients using biological agents should also be questioned and examined in terms of neurological symptoms, and further examination should be applied if necessary. No significant relationship was found between discontinuation of biological drugs and improvement/progression of neurological symptoms, and more comprehensive studies are needed.
Disclosure of Interests: None declared