OP0060 EXPOSURE TO SPECIFIC TUMOR NECROSIS FACTOR INHIBITORS AND RISK OF DEMYELINATING AND INFLAMMATORY NEUROPATHY IN PATIENTS WITH INFLAMMATORY ARTHRITIS. A COLLABORATIVE OBSERVATIONAL STUDY ACROSS FIVE NORDIC RHEUMATOLOGY REGISTERS

• Published in: Annals of the Rheumatic Diseases
• Main Authors: Delcoigne, B., Kopp, T. I., Arkema, E., Hellgren, K., Aarrestad Provan, S., Relas, H., Aaltonen, K., Trokovic, N., Gudbjornsson, B., Gröndal, G., Kristianslund, E., Dreyer, L., Askling, J.
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMJ 2022
• Subjects: General Biochemistry, Genetics and Molecular Biology; Immunology; Immunology and Allergy; Rheumatology; Norway; DML; Iceland
• Online Access: http://dx.doi.org/10.1136/annrheumdis-2022-eular.2866; https://syndication.highwire.org/content/doi/10.1136/annrheumdis-2022-eular.2866

Background Though rare, studies have reported increased risk of neurological events including demyelinating disease of CNS (DML), multiple sclerosis (MS), and inflammatory neuropathy (INP) in patients with inflammatory joint disease treated with tumor necrosis factor inhibitors (TNFi). 1,2 More in-depth investigations are required to elucidate the association between TNFi and neurological events in these patients, especially whether rates differ across type of TNFi mode of action. Objectives To estimate the incidence of neurological events in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA, including axial spondyloarthritis and psoriatic arthritis) starting treatment with TNFi across five Nordic countries. To compare the incidence of neurological events in etanercept (ETN)-treated patients to patients treated with other TNFi (oTNFi). Methods We defined treatment cohorts of patients initiating TNFi between 2001 through 2018 from clinical rheumatology registers in Denmark (DK), Finland (FI), Iceland (IS), Norway (NO), and Sweden (SE). One patient could contribute to more than one treatment episode. Demographic data (sex, age), co-medication (methotrexate) and clinical variables (CRP, disease duration (<1 year, 1 to 5 years, >5 years) were extracted and used as covariates. We estimated crude incidence rates (IR) for neurological events and subtypes (ICD-10 codes: MS: G35, DML: G35, G36.0, G36.8-9, G37.1, G37.3, G37.5, G37.8-9, H46, H48.1, G04.8-9, INP: G61.0, G61.8-9), all countries pooled. We compared risk of neurological events between patients treated with ETN and oTNFi using Cox regression with time since treatment start, adjusted for the above covariates, robust standard errors, and stratified by country. Results We included 52,682 treatment starts, in 33,885 RA patients (DK 8,259, FI 3,765, IS 723, NO 1353, SE 19,785; 75% women, mean age 56 years) and 46,549 treatment starts in 28,772 SpA patients (DK 7,000, FI 2,885, IS 962, NO 2,684, SE 15,241; 47% women, mean age 45 years). Numbers ...