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TNF‐β inhibitors in preventing mild cognitive impairment (MCI), dementia, and Alzheimer's disease (AD): An updated retrospective review using both EMR and claims data
Author(s) -
Stacey Jennifer L.
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.046502
Subject(s) - medicine , adalimumab , dementia , golimumab , etanercept , infliximab , cohort , propensity score matching , retrospective cohort study , cohort study , confounding , comorbidity , disease , oncology , rheumatoid arthritis
Background It is widely believed that inflammation contributes to the pathogenesis of AD. TNF‐α has been implicated in both AD and neurological inflammation. Previous research found anti‐TNF‐α therapies to be of potential benefit for preventing AD, and here updated analyses further contribute to this research while incorporating preceding diagnoses as potential outcomes. Method Patients were identified as either receiving an anti‐TNF‐α drug (etanercept, adalimumab, certolizumab, infliximab, or golimumab) or patients who were anti‐TNF‐α naïve receiving methotrexate (MTX). Patient cohorts were generated in both an electronic medical records (EMR) research network of 59M patient lives and a 201M patient network of linked primary care data with medical and pharmacy claims. Neither cohort had MCI (ICD‐9 331.83 or ICD‐10 G31.84), dementia (ICD‐9 290 or 294.1 or 294.2 or ICD‐10 F02 or F03), or AD (ICD‐9 331.0 or ICD‐10 G30) prior to the outcome window. The risk of MCI, dementia, and AD from 1 year after first exposure to either anti‐TNF‐α or MTX were analyzed using measures of association and survival analysis conducted via Kaplan‐Meier estimator. Cohort comparisons were run with propensity score matching (PSM) to control for demographic, comorbidity, medication, and diagnostic procedure confounders. Result There was significant MCI, dementia, and AD prevention with anti‐TNF‐α treatment compared to MTX found in both EMR and claims data networks without and with PSM. Only exception was EMR outcomes of AD with PSM (Risk Difference 0.04%; 95% CI (‐0.003%,0.079%); p=0.0679). [See Table 1]. Time to outcomes were measured up to 7,000 days in the EMR cohort up to 6,000 days post index in the claims cohorts. Conclusion This study provides further RWD based evidence that points to anti‐TNF‐α therapies as a beneficial therapy in the prevention of MCI, dementia, and AD. Further research is warranted to investigate these findings in larger cohorts and for outcomes to be monitored in a longer observation window.