Demyelinating events in rheumatoid arthritis after drug exposures

S Bernatsky, C Renoux, S Suissa - Annals of the rheumatic diseases, 2010 - ard.bmj.com
S Bernatsky, C Renoux, S Suissa
Annals of the rheumatic diseases, 2010ard.bmj.com
Objective To estimate the effects of biological drugs on the risk of demyelinating events in
rheumatoid arthritis (RA). Methods Case–control analyses nested in an administrative
database cohort. Results Initially the risk of demyelinating events appeared to be increased
after exposure to anakinra and decreased after exposure to antitumour necrosis factor (anti-
TNF) agents. However, this apparent differential risk was due to more anakinra use (and
avoidance of anti-TNF agents) in persons at high risk for demyelinating events. In individuals …
Objective
To estimate the effects of biological drugs on the risk of demyelinating events in rheumatoid arthritis (RA).
Methods
Case–control analyses nested in an administrative database cohort.
Results
Initially the risk of demyelinating events appeared to be increased after exposure to anakinra and decreased after exposure to antitumour necrosis factor (anti-TNF) agents. However, this apparent differential risk was due to more anakinra use (and avoidance of anti-TNF agents) in persons at high risk for demyelinating events. In individuals not at high risk, the adjusted rate ratio was 1.31 (95% CI 0.68 to 2.50) after exposure to anti-TNF agents and 0.80 (95% CI 0.29 to 2.24) after exposure to anakinra.
Conclusions
When accounting for differential prescription patterns, there was a trend towards more events after exposure to anti-TNF agents. When studying rare but important potential drug associations, pharmacoepidemiological studies are valuable but must be carefully performed.
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