In the past, certain research has suggested a relationship between the use of therapies like TNF inhibitors, tocilizumab, and tofacitinib, and a heightened risk of Alzheimer’s disease (AD) or dementia. According to the American Journal of Managed Care (AJMC), researchers recently sought to understand if this was true. Was there a relationship with these therapies, used for patients with rheumatoid arthritis (RA), and dementia risk? 

After evaluating data from a 10-year period, the researchers found that these treatments did not significantly influence the risk of dementia. The research team also compared the therapies to abatacept, another RA treatment option. Ultimately, this confirmed the findings of no increased risk. To check out the full study findings, take a look at JAMA Open Network. 

What are TNF Inhibitors?

To begin, let’s take a look at what TNF inhibitors are. According to the U.S. Food and Drug Administration (FDA), TNF inhibitors, also known as TNF blockers:

Suppress the immune system by blocking the activity of TNF, a substance in the body that can cause inflammation and lead to immune-system diseases such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis, …and plaque psoriasis.

Examples of TNF inhibitors include: 

• Adalimumab
• Cimzia
• Etanercept
• Remicade

Evaluating this Study

Within this study, researchers sought to evaluate the impact of TNF inhibitors, tocilizumab, or tofacitinib on RA – particularly in comparison with abatacept. The first three therapies are considered disease-modifying anti-rheumatic drugs (DMARDs). Altogether, researchers evaluated data from 22,569 individuals, aged 65+, with rheumatoid arthritis. Of these, 11,976 (53%) were using TNF inhibitors, 6,369 (28.2%) were using tocilizumab, and the remaining 4,224 (18.8%) were using tofacitinib. 

Researchers found that:

• Tocilizumab and tofacitinib were more likely to be used as second-line treatments than first-line treatments. 
• Many patients with rheumatoid arthritis had other comorbidities, such as high blood pressure and diabetes.
• Patients in all different cohorts (based on the specific therapies) saw similar incidences of dementia or Alzheimer’s disease. These therapies did not show any increased risk of dementia compared to other care options such as abatacept. 

About Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is an autoimmune and chronic inflammatory disorder which affects the joints. Most often, RA affects joints in the hands and feet. The condition occurs when the body’s immune system mistakenly attacks healthy cells and joints, causing inflammation, stiffness, and pain. Risk factors include being female, being obese, smoking cigarettes, or increasing age. Patients may experience periods of symptoms punctuated by periods of remission. Because RA is so variable, it can be difficult to predict. Symptoms can include:

• Joint, back, or muscle pain, stiffness, swelling, and tenderness
• Restricted mobility
• Fatigue and general malaise
• Fever
• Anemia (low red blood cell count)
• Bumps or swelling on the fingers
• Lumps or redness under the skin
• Unintended weight loss
• Dry mouth
• “Pins and needles” sensation