Methotrexate and relative risk of dementia amongst patients with rheumatoid arthritis: a multi-national multi-database case-control study

• Published in: Alzheimer's research & therapy Vol. 12; no. 1; p. 38
• Main Authors: Newby, Danielle, Prieto-Alhambra, Daniel, Duarte-Salles, Talita, Ansell, David, Pedersen, Lars, van der Lei, Johan, Mosseveld, Mees, Rijnbeek, Peter, James, Glen, Alexander, Myriam, Egger, Peter, Podhorna, Jana, Stewart, Robert, Perera, Gayan, Avillach, Paul, Grosdidier, Solène, Lovestone, Simon, Nevado-Holgado, Alejo J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.04.2020; BioMed Central; BMC
• Subjects: Age; Alzheimer's disease; Anti-inflammatory agents; Anti-inflammatory drugs; Antibiotics; Antineoplastic agents; Arthritis; Body mass index; Cognitive ability; Comparative analysis; Data collection; Dementia; DMARDs; Drug dosages; Drug therapy; Drug use; Electronic health records; Electronic records; Inflammation; Medical records; Medical research; Methotrexate; Neurodegeneration; Patients; Prescription drugs; Prevention; Primary care; Rheumatoid arthritis; Rheumatoid factor; Sulfasalazine; Europe; United Kingdom > UK; Anti-inflammatory drugs; EMIF; Rheumatoid arthritis; European Medical Information Framework; Case-control study; Sulfasalazine; Inflammation; DMARDs; Methotrexate; Dementia
• ISSN: 1758-9193; 1758-9193
• DOI: 10.1186/s13195-020-00606-5

Inflammatory processes have been shown to play a role in dementia. To understand this role, we selected two anti-inflammatory drugs (methotrexate and sulfasalazine) to study their association with dementia risk. A retrospective matched case-control study of patients over 50 with rheumatoid arthritis (486 dementia cases and 641 controls) who were identified from electronic health records in the UK, Spain, Denmark and the Netherlands. Conditional logistic regression models were fitted to estimate the risk of dementia. Prior methotrexate use was associated with a lower risk of dementia (OR 0.71, 95% CI 0.52-0.98). Furthermore, methotrexate use with therapy longer than 4 years had the lowest risk of dementia (odds ratio 0.37, 95% CI 0.17-0.79). Sulfasalazine use was not associated with dementia (odds ratio 0.88, 95% CI 0.57-1.37). Further studies are still required to clarify the relationship between prior methotrexate use and duration as well as biological treatments with dementia risk.