Neurological side effects seen in patients receiving Tumor Necrosis Alpha Inhibitor, its treatment and its relationship with disease progression

Introduction: Disease-modifying antirheumatic drugs (DMARDs = Disease Modifying Antirheumatic Drugs) are the general name given to drugs used in the treatment of inflammatory rheumatic diseases and slowing or stopping the progression of the disease by affecting the pathogenesis of rheumatic diseases. Treatments in this group, called biological therapy, have targeted specific cell pathways or cytokines, offering new solutions to unmet treatment needs in the treatment of various oncological and hematological diseases, especially inflammatory rheumatic diseases. Among the biological treatments, anti-TNFs are the most commonly used drugs in rheumatological diseases. With the increasing use of biologic therapies today, a number of demyelinating events have been reported, including CNS (Central Nervous System) demyelinating disorders and peripheral nervous system demyelinating disorders. Objective: In this study, we aimed to evaluate various variables such as neurological side effects, frequency, type and severity of neurological symptoms related to these treatments, discontinuation of rheumatic treatment and course of symptoms. the need for additional neurologic therapy. Methods: Patients who were followed up in the DEÜTF Rheumatology outpatient clinic between January 2011 and January 2020 and using TNFi for the diagnosis of any rheumatic disease and registered in the TÜRKBİO database were included in this retrospective cohort study. Various variables related to the type, severity and duration of neurological symptoms developing in patients at any time interval and their relationship to biological therapy, additional imaging needs of patients, and various laboratory tests were retrospectively analyzed and recorded. Results: Neurological side effects were seen in 16 (1,8%) of 877 patients who received biologic therapy. Of these 16 patients, 13 (81,25%) were diagnosed with SpA, three (18,75%) with seropositive RA. The mean time to develop neurological side effects after biological treatment was 26,37±29,58 months. Biological therapy was discontinued in 68,8% of the patients. There was no significant relationship between continuing biological therapy and neurological symptoms (stable/advanced/regressed). Conclusion : Discontinuation of the biological agent for the neurological side effect that occurs during biological therapy seems to be ineffective in the improvement of neurological symptoms. This has brought to mind the idea that biological agents can be unfairly accused in this regard. Therefore, more comprehensive studies in larger patient groups are needed to examine the relationship between biologic drugs and neurological side effects.