HealthDay News — For patients with rheumatoid arthritis aged 65 years and older, the risk of Alzheimer disease and related dementia (ADRD) does not differ with tofacitinib, tocilizumab, or tumor necrosis factor (TNF) inhibitors compared with abatacept, according to a study published online April 8 in JAMA Network Open.

Rishi J. Desai, Ph.D., from Brigham and Women’s Hospital in Boston, and colleagues examined the association between treatment with tofacitinib, tocilizumab, or TNF inhibitors compared with abatacept (as an active comparator) among patients with rheumatoid arthritis aged 65 years and older from 2007 to 2017. The main outcome was ADRD onset examined in four alternative analysis schemes.

Data were included for 22,569 propensity score-matched patient pairs, including 4,224 tofacitinib pairs, 6,369 tocilizumab pairs, and 11,976 TNF inhibitor pairs. The researchers found that across analyses schemes, the incidence rates of ADRD varied from 2 to 18 per 1,000 person-years. No statistically significant associations for ADRD were seen with tofacitinib, tocilizumab, or TNF inhibitors compared with abatacept. The results were consistent in prespecified subgroup analysis by age, sex, and baseline cardiovascular disease, except in patients with cardiovascular disease, who had a potentially lower risk of ADRD with TNF inhibitors versus abatacept in two of the four analyses.


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“Careful design choices and nuanced interpretation of results are important for generating valid, actionable evidence on drug repurposing questions explored using routine health care data,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text