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Adverse events of grade 3 or 4 severity included thrombocytopenia, fatigue, anemia, and pneumonia

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Adverse effects of biologic drugs More common side effects include: a higher risk of respiratory or urinary tract infections headaches flu-like symptoms, such as low energy and body aches reactions at the injection site, such as discoloration, swelling, or discomfort Rarer side effects include: blood disorders a higher risk of certain cancer types an increased risk of serious nervous system disorders, including multiple sclerosis (MS), nervous system inflammation, and seizures Adverse effects of methotrexate Methotrexate is not a biologic drug, and it has different side effects

No significant difference in the prevalence of symptoms was found between participants with MMA levels 400 nmol/l (n = 60) and those whose levels were 600 nmol/l showed some improvement in neurological symptoms (Hvas, 2001b)

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