TNF inhibitors increase risk of inflammatory CNS events
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TNF inhibitors increase risk of inflammatory CNS events Treatment with tumour necrosis factor (TNF) inhibitors in patients with autoimmune diseases appears to increase the risk of inflammatory CNS events, according to findings of a study published in JAMA Neurology. This nested case-control study used data from electronic medical records at Mayo Clinics in three US states between January 2003 and February 2019 to investigate the association between TNF inhibitor therapy (adalimumab, certolizumab pegol, etanercept, golimumab or infliximab) and inflammatory demyelinating CNS events (including multiple sclerosis and optic neuritis) and nondemyelinating CNS events (including encephalitis, meningitis, meningoencephalitis, neurosarcoidosis or CNS vasculitis) in 212 patients with FDA-approved indications (autoimmune diseases including inflammatory bowel disease or autoimmune rheumatic diseases). Patients with inflammatory CNS events (cases; n=106) were matched to the same number of patients without inflammatory CNS events (controls); 60% of cases and 40% of controls received TNF inhibitors. Significant associations were found between use of TNF inhibitors and the overall risk of inflammatory CNS events (adjusted odds ratio [aOR] 3.01; 95% CI 1.55, 5.82; p=0.001), the risk of demyelinating CNS events (aOR 3.09; 95% CI 1.19, 8.04; p=0.02), and the risk of nondemyelinating CNS events (aOR, 2.97; 95% CI 1.15, 7.65; p=0.02). The association between TNF inhibitor use and the risk of inflammatory CNS events was greatest in patients with rheumatoid arthritis (aOR 4.82; 95% CI 1.62, 14.36; p=0.005). "In this study population, TNF inhibitor exposure in patients with autoimmune diseases appeared to be associated with an increased risk of both inflammatory demyelinating and nondemyelinating CNS events. Further research is needed to explore whether this association indicates de novo inflammation or exacerbation of already aberrant inflammatory pathways," concluded the authors. Kunchok A, et al. Association Between Tumor Necrosis Factor Inhibitor Exposure and Inflammatory Central Nervous System Events. JAMA Neurology : 18 May 2020. 803499039 Available from: URL: http://dx.doi.org/10.1001/jamaneurol.2020.1162
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Reactions 29 Aug 2020 No. 1819
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