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Multiple sclerosis (MS) is a chronic inflammatory neurological disease with multifactorial aetiology.1 Evidence of tumour necrosis factor (TNF)-α as an important factor in the pathogenesis of MS has emerged.2 However, attempts of treating MS with TNF-inhibitors (TNFi) have increased disease activity.3 Several case reports have indicated that demyelinating diseases could be a serious adverse event following TNFi treatment while data from the Spanish Registry of biological therapies in rheumatic diseases did not bring clarification.4 ,5 Some, but not all, studies have suggested a negative association between rheumatoid arthritis (RA) and MS.6 ,7
We aimed to investigate whether TNFi treatment in patients with arthritis is associated with an increased risk of developing MS and whether RA is associated with a decreased risk compared with the general population.
The nationwide Danish DANBIO Registry started in 2000 and covers >90% of adults with rheumatological disease treated with TNFi in routine care.8 Since 2005, patients not treated with …
Contributors All authors made substantial contributions to the design of the work, interpretation of data and revising of the manuscript. BJ made the statistical analyses. LD drafted the manuscript. All authors gave final approval of the version published.
Funding The study is supported with grants from the Danish Rheumatism Association.
Competing interests FS reports grants and personal fees from Biogen, personal fees from Teva, grants and personal fees from Novartis, personal fees from Merck, grants and personal fees from EMD Serono, personal fees from Genzyme, outside the submitted work. LD has received honoraria from MSD and UCB for talks.
Ethics approval The project is entirely register-based, and the patients have not been contacted. Therefore, no approval by the Ethical Committees was needed according to Danish law. Approval by the Danish Data Protection Board Agency was obtained.
Provenance and peer review Not commissioned; externally peer reviewed.