Exposure to specific tumour necrosis factor inhibitors and risk of demyelinating and inflammatory neuropathy in cohorts of patients with inflammatory arthritis : a collaborative observational study across five Nordic rheumatology registers

• Published in: RMD Open
• Main Authors: Delcoigne, Benedicte, Kopp, Tine Iskov, Arkema, Elizabeth V., Hellgren, Karin, Provan, Sella Aarrestad, Relas, Heikki, Aaltonen, Kalle, Trokovic, Nina, Guðbjörnsson, Björn, Gröndal, Gerður María, Klami Kristianslund, Eirik, Lindhardsen, Jesper, Dreyer, Lene, Askling, Johan
• Other Authors: Faculty of Medicine, Other departments
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2023
• Subjects: Gigtarlæknisfræði; Ankylosing; Arthritis; Psoriatic; Rheumatoid; Spondylitis; Tumor Necrosis Factor Inhibitors; Humans; Rheumatology; Antibodies; Monoclonal; Rheumatoid/complications; Tumor Necrosis Factor Inhibitors/adverse effects; Etanercept/adverse effects; Psoriatic/complications; Immunology and Allergy; Immunology; Norway; Alf; DML
• Online Access: https://hdl.handle.net/20.500.11815/4176; https://doi.org/10.1136/rmdopen-2022-002924

Funding Information: This work was supported by NordForsk and the Foundation for Research in Rheumatology (Foreum) and Vinnova. The research infrastructure was supported by funds from the Swedish Research Council, the Swedish Heart Lung Foundation and the Swedish Cancer Society, and funds from Region Stockholm-Karolinska Institutet (ALF). The Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) (Norway) is funded as a Centre for Clinical Treatment Research by the Research Council of Norway (project 328657). Publisher Copyright: © 2023 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To compare incidences of neuroinflammatory events, including demyelinating disease (DML), inflammatory polyneuropathies (IPN) and multiple sclerosis (MS), in patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA; including psoriatic arthritis) starting a tumour necrosis factor inhibitor (TNFi), investigating whether monoclonal TNFi antibodies (other TNFis (oTNFis)) confer higher risk than etanercept. Methods This is an observational cohort study including patients from the five Nordic countries starting a TNFi in 2001-2020. Time to first neuroinflammatory event was identified through register linkages. We calculated crude incidence rates (cIR) per 1000 person-years and used multivariable-adjusted Cox regression to compare incidences of neuroinflammatory events overall and for DML, IPN and MS with oTNFi versus etanercept. We further examined individual TNFis and indications. Results 33 883 patients with RA and 28 772 patients with SpA were included, initiating 52 704 and 46 572 treatment courses, respectively. In RA, we observed 135 neuroinflammatory events (65% DML) with cIR of 0.38 with oTNFi and 0.34 with etanercept. The HR of oTNFi versus etanercept was 1.07 (95% CI 0.74 to 1.54) for any neuroinflammatory event, 0.79 (95% CI 0.51 to 1.22) for DML, 2.20 (95% CI 1.05 to 4.63) for IPN and 0.73 (95% CI 0.34 ...