Incidence of dementia in patients with rheumatoid arthritis and association with disease modifying anti-rheumatic drugs – Analysis of a national claims database

• Published in: Seminars in arthritis and rheumatism 2022-12, Vol.57, p.152083-152083, Article 152083
• Main Authors: Sattui, Sebastian E., Navarro-Millan, Iris, Xie, Fenglong, Rajan, Mangala, Yun, Huifeng, Curtis, Jeffrey R.
• Format: Article
• Language: English
• Subjects: Dementia; Disease modifying antirheumatic drugs; Rheumatoid arthritis; Tumor necrosis alpha inhibitors
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2022.152083

•Growing evidence highlight the role of neuroinflammation, and systemic inflammation, in the development of dementia.•Recent studies have shown an increased risk for dementia in patients with rheumatoid arthritis.•Compared to patients with RA using csDMARDs only, patients with RA receiving b/tsDMARDs had a 19% decreased risk of incident dementia.•In patients with RA, use of b/tsDMARDs, independent of mechanism of action or pathway, was associated with a decreased incidence of dementia when compared to csDMARDs only. To evaluate the risk of incident dementia associated with the use of biologics or targeted synthetic DMARDs (b/tsDMARD) compared to conventional synthetic (cs) DMARDS only in patients with rheumatoid arthritis (RA). We analyzed claims data from the Center for Medicare & Medicare Services (CMS) from 2006-2017. Patients with RA were identified as adults ≥40 years old and two RA diagnoses by a rheumatologist > 7 and < 365 days apart. Patients with a prior diagnosis of dementia were excluded. Use of cs/b/tsDMARDs was the exposure of interest. Person-time was classified as either: 1) b/tsDMARD exposed, which included tumor necrosis factor alpha inhibitors (TNFi)-bDMARDs, non-TNFi-bDMARDs or tsDMARDs with or without csDMARDs; 2) csDMARD-exposed: any csDMARD without b/tsDMARD. Patients could contribute time to different exposure groups if they changed medications. Incident dementia was defined as: 1 inpatient OR 2 outpatients ICD-9-CM or ICD-10 claims for dementia, OR prescription of a dementia-specific medication (rivastigmine, galantamine, memantine, donepezil, tacrine). Age-adjusted incident rates (IR) were calculated, and univariate and multivariate Cox proportional hazard models were used to calculate Hazard Ratios (HR) and 95% confidence intervals (CI). We identified 141,326 eligible RA patients; 80% female and 75.3% white, median age 67 years and mean (SD) exposure time of 1.1 (1.5) years. There were 233,271 initiations of c/b/tsDMARDS and 3,794 cases of incident dementia during follow up. The crude IR of dementia was 2.0 (95% CI 1.9-2.1) per 100 person-years for patients on csDMARDs and 1.3 (95% CI 1.2-1.4) for patients on any b/tsDMARD. Patients on b/tsDMARDs had an adjusted 19% lower risk for dementia than patients on csDMARDs [HR 0.81 (95% CI 0.76-0.87)]. Subgroup analysis found comparable risk reductions between TNFi, non-TNFi, and tsDMARDs. on the risk of dementia. The incidence of dementia in patients with RA was lower in patients receiv