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Demyelinating events in rheumatoid arthritis after drug exposures
  1. Sasha Bernatsky1,2,
  2. Christel Renoux3,
  3. Samy Suissa3
  1. 1Division of Rheumatology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
  2. 2Division of Clinical Epidemiology, Research Institute of the MUHC, Montreal, Quebec, Canada
  3. 3Centre for Clinical Epidemiology, Jewish General Hospital – Lady Davis Institute, Montreal, Quebec, Canada
  1. Correspondence to Samy Suissa, Centre for Clinical Epidemiology, Jewish General Hospital – Lady Davis Institute, 3755 Cote Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada; samy.suissa{at}


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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  • Funding SB is the recipient of career awards from the Canadian Institutes for Health Research (CIHR), Fonds de recherche en santé du Québec (FRSQ), Canadian Arthritis Network and of support from the McGill University Research Institute and Faculty of Medicine. SS is the recipient of the James McGill professorship and the CIHR distinguished investigator award. The McGill Pharmacoepidemiology Research Unit is funded by the FRSQ. CR is the recipient of a postdoctoral fellowship from the Multiple Sclerosis Society of Canada.

  • Ethics approval This study was conducted with the approval of the Commission d'acces a l'information du Quebec.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.