There have been reports of multiple sclerosis, demyelination, and optic neuritis associated with anti-tumor necrosis factor α therapy.
This resulted in warnings on prescribing instructions for infliximab, etanercept, and adalimumab.
However, the underlying relationship between inflammatory bowel disease (IBD) and these neurologic conditions has not been established.
Dr James Lewis and colleagues performed a retrospective cohort study and a retrospective cross-sectional study.
The researchers analyzed 1988 to 1997 data from the General Practice Research Database.
A total of 7988 Crohn's disease and 12,185 ulcerative colitis patients were included.
|Incidents of demyelinating diseases reached statistical significance for ulcerative colitis|
The patients were matched for age, sex, and primary care practice to 80,666 randomly selected controls.
In the cohort study, incident cases of multiple sclerosis, demyelination, and/or optic neuritis had to occur at least 1 year after registration with the physician.
The team also reported that the demyelinating diseases had to occur after the diagnosis of IBD.
In the cross-sectional study, the diagnosis of the demyelinating diseases mentioned could either precede or follow the IBD diagnosis.
The researchers found in the cohort study, that the incidence of the demyelinating diseases was higher in Crohn's and ulcerative colitis compared with the controls.
The team noted that the incidence of the demyelinating diseases reached statistical significance for ulcerative colitis.
In the cross-sectional study, multiple sclerosis, demyelination, and/or optic neuritis was more prevalent in Crohn's and ulcerative colitis compared with controls.
Dr Lewis' team concludes, “Demyelinating diseases occur more commonly among patients with IBD than among non-IBD patients.”
“Future studies should clarify whether treatment with tumor necrosis factor α blockers results in further increased incidence of multiple sclerosis, demyelination, and/or optic neuritis among IBD patients.”