1095: Tolerance of non-TNF α treatments in patient with an inflammatory rheumatic (IRD) and autoimmune demyelinating diseases: French retrospective cases series

Background/Purpose: The use of TNFα antagonist is not recommended if the patient have a suspicion or demyelinating diseases (DD) confirmed [1]. There are a few cases reported that non-TNFi targeted are used in this situation [2-3].


To establish the evolution of DD (stability, aggravation) in patients with a rheumatic disease receiving biological non TNFαi or synthetic therapies, in a retrospective French cohort study.




Methods: A retrospective French multicenter descriptive, national study. Reported cases followed notifications via the CRI (Club Rhumatisme Inflammatoire) newsletter.
Inclusion criteria: Patients > 18 years of age, with IRD (rheumatoid arthritis [RA], spondyloarthritis [SpPA], psoriatic arthritis [psoriatic arthritis]), treated with a non TNFi targeted therapy for more than 3 months, and presenting with demyelinating disease (MS and/or neurological manifestations suggestive of demyelinating disease), whether or not they occurred while on TNFi therapy.

Results: 51 patients received at least one non-TNF targeted therapy (33 SpA, 13 RA, 5 R Pso), with clinical, biological and therapeutic characteristics at Baseline. The mean age of diagnosis of demyelinating pathology was 37.8 years (12-76) in the SpA group, 42.7 (24-58) in the RA group and 45.8 (32-56) in the R Pso group.
51% (n=26) had at least one prior exposure to an anti-TNF before the onset of demyelinating pathology (21 SPA, 1 Rpso, 4 PR). Exposure to non-TNF treatments in the different therapeutic lines is: 40 patients to anti-IL17 with a mean duration of 25 months (2-103), 5 patients to Anti-IL6R with a mean duration of 42.2 months (21-133), 9 patients to CTLA-4Ig (Abatacept) with a mean duration of 18.6 months (3 -64), 7 patients to Jaki with a mean duration of 19.3 months (2-38), 2 patients to anti-IL23 with a mean duration of 8.5 (7-10), 12 patients to anti-CD20 with a mean duration of 18.1 months (4-118), 1 patient to apremilast (phosphodiesterase 4 (PDE4) inhibitor) with a mean duration of 29 months and 3 patients to anti-IL-12 and IL-23 with a mean duration of 31.5(14-64).
100% of patients (n=51) had stability or improvement of demyelinating pathology.
The combination in 6 patients treated with secukinumab, 1 patient with tocizulumab, and 1 patient with rituximab with a background MS treatment (interferon beta, teriflunomide, ocrelizumab, glatiramer acetate) was well tolerated.

Conclusion: The use of non-anti-TNF targeted therapies (anti-IL17, anti-IL6R, CTLA-4Ig, Jaki, anti-IL23, anti-CD20, PDE4 inhibitor, and anti-IL-12 and IL-23) in patients with RIC does not appear to worsen demyelinating disease.