TNF Inhibitors and Peripheral Neuropathy

Introduction to TNF Inhibitor-Associated Risks

• The American Academy of Dermatology recommends that TNF inhibitors be avoided in patients with pre-existing demyelinating conditions, as they carry a rare but documented risk of peripheral neuropathy (0.4-0.6% incidence), and if neurological symptoms develop during treatment, the TNF inhibitor should be immediately withheld and urgent neurological evaluation should be obtained 1

Contraindications and Management

• The American Academy of Dermatology suggests that TNF inhibitors should be avoided entirely in patients with a personal history of demyelinating disorders, representing an absolute contraindication based on the mechanism by which these agents can trigger or exacerbate demyelinating conditions 1, 2
• The American Academy of Dermatology recommends that when neurological symptoms develop, the TNF inhibitor should be immediately withheld and prompt neurological evaluation should be arranged 1, 2