Neurological and MRI Screening Improves Long-term anti-TNF-alpha Treatment Safety in Patients with Crohn's Disease

Background: Several reports describe MRI signs of CNS demyelination in inflammatory bowel diseases (IBD) patients treated with monoclonal antibody against tumor necrosis factor alpha (anti-INF-alpha) and even indicate that anti-INF-alpha can trigger multiple sclerosis (MS). The first aim of the study was to evaluate the neurological status of Crohn's disease (CD) patients before anti-INF-alpha therapy initiation in order to avoid possible complications in patients with latent demyelinating diseases. Our second aim was to evaluate, by prospectively following their neurological and MRI status, the risk of developing CNS demyelination in patients with CD treated with anti-INF-alpha. Methods: Fifty patients, followed for more than 2 years, were included in the prospective phase of the study. Thirty of these patients were treated with anti-INF-alpha. Twenty patients without biological therapy were used as controls. Neurostatus and brain MRI were performed in all patients at baseline and after 1.5 years of treatment. CSF examination was performed if MRI raised suspicion of MS. Results: 54% of patients had abnormalities in neurostatus. MRI changes suggestive of demyelination were found in seven cases. In one patient, CSF-specific oligoclonal bands were found and anti-INF-a treatment was contraindicated. No changes in neurological or MRI status were observed after 1.5 years of treatment in either group. Conclusions: Preselection of patients at high risk of developing MS can increase the safety of anti-INF-alpha treatment.