Classical disease-modifying antirheumatic drugs (cDMARDs) may become a new treatment option for patients with dementia for whom no pharmacologic drug treatments are available or recommended, according to a study published in Alzheimer’s & Dementia.1
Protective effects of arthritis or anti-inflammatory drugs in dementia have previously been observed.2 To further evaluate this drug-specific effect, a population-based retrospective cohort study was conducted in patients with rheumatoid arthritis (RA).1 Data from 3876 cDMARD users were matched with data from 1938 nonusers. Of the cDMARD users, 60.8% received methotrexate and 39.2% received other cDMARDs.
Patients were followed up to 15 years from the date of RA diagnosis. Study outcome was incident dementia, which included Alzheimer disease, vascular dementia, and mixed dementia.
A reduced risk for dementia was observed in cDMARD users compared with nonusers at 5 years (0.5% vs 1.6%, respectively) and at 15 years (1.5% vs 3.0%, respectively). The strongest effect was observed in methotrexate users (hazard ratio 0.52; 95% CI, 0.34-0.82) compared with non-methotrexate users (hazard ratio 0.70; 95% CI, 0.32-1.08).
Using Kaplan-Meier plots, a significant difference in the risk for dementia between cDMARD users and nonusers was first observed at approximately 3 years of follow-up and remained significant at more than 10 years of follow-up.
A possible limitation of the study was the lack of validation of individual cases of dementia from the data source.1 However, this study had many strengths, including use of a matched population, which minimizes bias as a result of confounding by indication.
The authors concluded that, “This study is the first to demonstrate a strong beneficial effect of cDMARDs by suggesting a halving of risk of dementia.” Further exploration in future randomized controlled studies is needed.
- Judge A, Garriga C, Arden NK, et al. Protective effect of antirheumatic drugs on dementia in rheumatoid arthritis patients. Alzheimers Dement (N Y). 2017;3(4):612-621.
- McGeer PL, Schulzer M, McGeer EG. Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer’s disease: a review of 17 epidemiologic studies. Neurology. 1996;47:425-432.