Contributions
Abstract: P754
Type: Poster
Abstract Category: Therapy - disease modifying - Others
Introduction: Tocilizumab is a recombinant human monoclonal antibody against the interleukin-6 receptor. Recently a case of a patient who developed multiple sclerosis (MS) while under treatment with Tocilizumab and methotrexate has been reported. So we describe a new case of Tocilizumab-related MS.
Case report: 41-year old woman was diagnosed with breast cancer 9 years ago and underwent successfully treatment with surgery, chemotherapy and radiotherapy. In 2014, she was diagnosed with Graves´ disease with orbitopathy and Tocilizumab treatment was begun. One year later acute weakness and numbness in her left hand appeared. Magnetic Resonance Imaging (MRI) showed more than 9 demyelinating lesions, some ovoid, located at subcortical, periventricular and infratentorial level. One of subcortical lesions was enhanced with gadolinium. Cerebrospinal fluid analysis presented positive IgG oligoclonal bands. Thyroid function, antithyroid peroxidase and antithyroglobulin antibodies were normal. Autoantibodies (ANA, anti-DNA, anti-ENA, ANCA) were negative. Tocilizumab was stopped and the patient was treated with high-dose intravenous methylprednisolone (1000 mg for 5 days). Six months later the patient was asymptomatic and there was no change in the number and size of lesions in her brain MRI, none of them indicating gadolinium enhancing.
Conclusions: It has been considered that IL6 has anti-inflammatory properties, therefore the effect of such anti-IL-6 agents as Tocilizumab may lead to demyelinating diseases. In fact, some central and peripheral inflammatory demyelinating diseases have been reported. Although its real implication is still unknown, practitioners should be cautious in respect to their usage, especially in patients with demyelinating diseases.
Disclosure:
Cruz-Velásquez G: nothing to disclose.
Artal J: nothing to disclose.
Sebastián B: has received honoraria for lecturing or travel expenses for attending meetings from Bayer, Biogen Idec, Genzyme and Novartis.
Seral M: has received honoraria for lecturing or travel expenses for attending meetings from Biogen Idec, Genzyme and Novartis.
Pérez-Moreira JV: nothing to disclose
Martín J: has received consulting honoraria from Genzyme, and honoraria for lecturing, travel expenses for attending meetings, or financial support for research from Bayer, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis and Teva.
Ara JR: has received consulting honoraria from Genzyme, and honoraria for lecturing, travel expenses for attending meetings, or financial support for research from Bayer, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis and Teva.
Abstract: P754
Type: Poster
Abstract Category: Therapy - disease modifying - Others
Introduction: Tocilizumab is a recombinant human monoclonal antibody against the interleukin-6 receptor. Recently a case of a patient who developed multiple sclerosis (MS) while under treatment with Tocilizumab and methotrexate has been reported. So we describe a new case of Tocilizumab-related MS.
Case report: 41-year old woman was diagnosed with breast cancer 9 years ago and underwent successfully treatment with surgery, chemotherapy and radiotherapy. In 2014, she was diagnosed with Graves´ disease with orbitopathy and Tocilizumab treatment was begun. One year later acute weakness and numbness in her left hand appeared. Magnetic Resonance Imaging (MRI) showed more than 9 demyelinating lesions, some ovoid, located at subcortical, periventricular and infratentorial level. One of subcortical lesions was enhanced with gadolinium. Cerebrospinal fluid analysis presented positive IgG oligoclonal bands. Thyroid function, antithyroid peroxidase and antithyroglobulin antibodies were normal. Autoantibodies (ANA, anti-DNA, anti-ENA, ANCA) were negative. Tocilizumab was stopped and the patient was treated with high-dose intravenous methylprednisolone (1000 mg for 5 days). Six months later the patient was asymptomatic and there was no change in the number and size of lesions in her brain MRI, none of them indicating gadolinium enhancing.
Conclusions: It has been considered that IL6 has anti-inflammatory properties, therefore the effect of such anti-IL-6 agents as Tocilizumab may lead to demyelinating diseases. In fact, some central and peripheral inflammatory demyelinating diseases have been reported. Although its real implication is still unknown, practitioners should be cautious in respect to their usage, especially in patients with demyelinating diseases.
Disclosure:
Cruz-Velásquez G: nothing to disclose.
Artal J: nothing to disclose.
Sebastián B: has received honoraria for lecturing or travel expenses for attending meetings from Bayer, Biogen Idec, Genzyme and Novartis.
Seral M: has received honoraria for lecturing or travel expenses for attending meetings from Biogen Idec, Genzyme and Novartis.
Pérez-Moreira JV: nothing to disclose
Martín J: has received consulting honoraria from Genzyme, and honoraria for lecturing, travel expenses for attending meetings, or financial support for research from Bayer, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis and Teva.
Ara JR: has received consulting honoraria from Genzyme, and honoraria for lecturing, travel expenses for attending meetings, or financial support for research from Bayer, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis and Teva.