Abstract Details

Title A Case of an Aggressive Demyelinating NMO Spectrum Disorder-like Event in a Rheumatoid Arthritis Patient Treated with Tofacitinib

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-016

Objective

To present clinical and neuroimaging characteristics of a patient with an acute, aggressive Neuromyelitis Optica Spectrum Disorder (NMOSD)-like demyelinating disease 5 days after initiation of oral tofacitinib for the treatment of seronegative RA as an adverse event.

Background Acute inflammatory demyelinating events have been associated with several rheumatoid arthritis(RA) medications. Tofacitinib, a janus kinase (JAK) inhibitor, was approved by the FDA in 2012 to treat RA. Concerns over possible similar events with this class of medication have been raised.

Design/Methods A retrospective chart review of a patient case.

Results A 56-year-old Caucasian woman with seronegative RA presented with acute right perioral facial numbness. MRI revealed restricted diffusion and T2 hyperintensity in the right middle cerebellar peduncle. 12 days later, she developed progressive bilateral lower extremity weakness that evolved to complete paraplegia and sensory loss below the level of T4 with bowel and bladder incontinence. Several days later, she developed visual loss in the left eye and right arm weakness. MRI revealed two separate longitudinally extensive T2 hyperintense/contrast enhancing lesions in the cervical and thoracic spinal cord and an enhancing left optic nerve. She was treated with IV steroids, IVIG, and plasma exchange with limited improvement in her symptoms and clinical examination. Given the treatment-refractory disease course, she was started on rituximab as well. Eight months later, she had persistent flaccid paraplegia and complete vision loss in the left eye with improvement in right arm weakness.

Conclusions Our patient likely developed a medication-related acute aggressive multifocal NMOSD-like demyelinating disease after initiation of an oral JAK inhibitor. Further vigilance for and evaluation of possible demyelinating events as related to tofacitinib is needed.

Authors/Disclosures
Svetlana Eckert, MD PRESENTER	Dr. Eckert has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Eckert has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMD Serono. Dr. Eckert has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for TG Therapeutics.
Bianca Weinstock-Guttman, MD (Department of Neurology, University At Buffalo)	Dr. Weinstock-Guttman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Weinstock-Guttman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Weinstock-Guttman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme &Sanofi. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen . Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Weinstock-Guttman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Weinstock-Guttman has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Janssen. Dr. Weinstock-Guttman has received personal compensation in the range of $0-$499 for serving as a Reviewer with NIH.
David Hojnacki, MD, FAAN (University At Buffalo, Jacobs Neurological Institute)	Dr. Hojnacki has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Hojnacki has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Hojnacki has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.

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