ObjectiveNeuroinflammatory adverse events have been observed among new users of tumor necrosis factor (TNF) inhibitors. No studies to date have compared the real-world risk of TNFs with other new users of biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). The objective of this study is to describe the risk of neuroinflammatory disease after initiation b/tsDMARDs.MethodsThis new user comparative effectiveness cohort study used a large US-based electronic health records database to describe the unadjusted incidence of neuroinflammatory adverse events over a 3-year period. The cohort included patients with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, or ulcerative colitis initiating treatment with a TNF inhibitor (n = 93,661) or other b/tsDMARD (n = 38,354).ResultsAmong 132,015 patients included in the analysis, the most common first biologic agent was a TNF inhibitor; the unadjusted incidence of neuroinflammatory events was numerically lower among new users of TNF inhibitors (incidence 1.34 per 1,000 patient-years) as compared with the combined non-TNF group (1.69 per 1,000 patient-years). There was no significant association between TNF exposure and neuroinflammatory events as compared with the combined non-TNF b/tsDMARDs overall (hazard ratio 1.01; 95% confidence interval 0.75-1.36) and within each disease group.ConclusionThe overall risk of neuroinflammatory events among new users of TNF inhibitors did not differ substantially as compared with new users of other b/tsDMARDs. Meta-analyses of randomized trials should be conducted to corroborate these findings, which may be affected by channeling bias.
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Univ New South Wales, St George Hosp, Dept Rheumatol, Sydney, NSW, Australia
Univ New South Wales, Sch Populat Hlth, Dept Med, Sydney, NSW, AustraliaCabrini Hlth, Monash Cabrini Dept Musculoskeletal Hlth & Clin E, Melbourne, Vic, Australia
Lassere, Marissa
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March, Lyn
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Hill, Catherine
Barrett, Claire
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Redcliffe Hosp, Dept Rheumatol, Redcliffe, Australia
Univ Queensland, Sch Med, Dept Med, Brisbane, Qld, AustraliaCabrini Hlth, Monash Cabrini Dept Musculoskeletal Hlth & Clin E, Melbourne, Vic, Australia
Barrett, Claire
Carroll, Graeme
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Fiona Stanley Hosp, Dept Rheumatol, Perth, WA, AustraliaCabrini Hlth, Monash Cabrini Dept Musculoskeletal Hlth & Clin E, Melbourne, Vic, Australia