title: Demyelinating disorders secondary to TNF-inhibitor therapy for the treatment of psoriasis: A review.
abstract: BACKGROUND
  Tumor necrosis factor-α inhibitors (TNFi) are the most widely used systemic treatments for patients with psoriasis and psoriatic arthritis. There currently exists a U.S. Food and Drug Administration issued warning label on all TNFi for "rare cases of new onset or exacerbation of central nervous system demyelinating disorders." The aim of this review was to update the incidence of TNFi-induced demyelinating diseases.
  
  
  METHODS
  Pubmed database was searched for safety data regarding demyelinating disease secondary to TNFi therapy prescribed for psoriasis.
  
  
  RESULTS
  In clinical trials: 6990 patients had received treatment with etanercept with one reported case of multiple sclerosis; 5204 patients were treated with adalimumab with no cases identified and 2322 patients were treated with infliximab with one case of demyelinating polyneuropathy. Outside of clinical trials: 19 individual cases of demyelinating disorders from TNFi treatment have been reported.
  
  
  CONCLUSIONS
  Although there is potential for TNF blockade to lead to demyelination of the central and peripheral nervous systems, the results of the present review suggest that demyelinating diseases associated with TNFi are extremely rare. TNFi are not recommended for use in patients with a personal history of demyelinating disease. However, with clinical vigilance and individualized treatment regimen, TNFi may be safe for use in other patients.
authors.affiliation: a University of Southern California Keck School of Medicine , Los Angeles , CA , USA .
authors.forename: Tian Hao
authors.initials: TH
authors.lastname: Zhu
authors.affiliation: b Department of Dermatology , Psoriasis and Skin Treatment Center, University of California San Francisco , San Francisco , CA , USA .
authors.forename: Mio
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: c University of California Irvine School of Medicine , Irvine , CA , USA , and.
authors.forename: Michael
authors.initials: M
authors.lastname: Abrouk
authors.affiliation: d University of Vermont College of Medicine , Burlington , VT , USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Farahnik
authors.affiliation: b Department of Dermatology , Psoriasis and Skin Treatment Center, University of California San Francisco , San Francisco , CA , USA .
authors.forename: John
authors.initials: J
authors.lastname: Koo
authors.affiliation: b Department of Dermatology , Psoriasis and Skin Treatment Center, University of California San Francisco , San Francisco , CA , USA .
authors.forename: Tina
authors.initials: T
authors.lastname: Bhutani
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D000068800:Etanercept / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D000069285:Infliximab / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Psoriasis; adalimumab; adverse event; demyelinating disorder; etanercept; infliximab; tumor necrosis factor-inhibitor