Psoriasis treatment with adalimumab leading to multiple sclerosis

Summary: Abstract Body: Since their introduction in 1999, anti-tumour necrosis factor-alpha (anti-TNF-alpha) therapies have been suspected repeatedly to be associated with the occurrence of central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS). However, recent publications were restricted to descriptions of monophasic demyelinating events or cases of relapsing–remitting MS (RRMS). We here provide the first case report of primary progressive MS (PPMS) onset upon anti-TNF-alpha therapy. The 51-year old male patient was treated with adalimumab due to psoriasis and psoriatic arthritis. About 18 months after treatment initiation, he developed slowly progressing neurological deficits including gait impairment, paresthesia of the lower limbs, strangury and visual impairment, which led to the discontinuation of adalimumab therapy. Magnetic resonance imaging of the brain and the spinal cord revealed multiple inflammatory lesions and cerebrospinal fluid examination showed slight pleocytosis and positive oligoclonal bands. Thus, PPMS was diagnosed according to the 2017 revision of the McDonald criteria. As PPMS often causes only subtle symptoms in the beginning and early treatment discontinuation of anti-TNF-alpha therapy seems essential to improve the patient’s outcome, it is also important to increase the awareness of slowly progressing neurological deficits as a potential adverse event of anti-TNF-alpha therapy among all clinicians involved in the initiation and monitoring of these drugs. In addition, the occurrence of both RRMS and progressive MS upon anti-TNF-alpha therapy might suggest a shared TNF-alpha-mediated pathophysiological mechanism in the evolution of all MS subtypes as an auto-immune event. Rudolf Schopf¹ 1. Dermatology, Johannes Gutenberg Universitat Mainz, Mainz, RP, Germany. Clinical Research: Epidemiology and Observational Research