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Anti-TNF drugs appear to lessen PD risk in IBD patients

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Big data links old drugs, new benefits

The research provides “a glimpse of the promise and beauty of big data for Parkinson’s disease (PD) and for neurology in general,” experts wrote in an editorial accompanying the study.

“Every physician knows how much can be learned by listening to a patient,” wrote Abby L. Olsen, MD, PhD, Trond Riise, PhD, and Clemens R. Scherzer, MD. “Imagine how much might be learned by scaling this singular experience to torrents of digital health data from millions of patients.”

If inflammatory bowel disease and PD share a common inflammatory etiology, anti–tumor necrosis factor therapy might well help prevent PD, they wrote. But a clinical trial testing that hypothesis would be “incredibly difficult and expensive” because PD has a fairly low incidence, even among people at increased risk.

To surmount this obstacle, the researchers created a “virtual” trial that repurposed old drugs for new potential benefit, the experts continued. Although the study fell short on follow-up time and certain clinical data (such as smoking status), it offered “exciting evidence” in support of this concept.

The editorialists are with Precision Neurology Program, Brigham and Women’s Hospital, Boston. These comments paraphrase their editorial (JAMA Neurol. 2018 Apr 23. doi: 10.1001/jamaneurol.2018.0345 ).



Patients with inflammatory bowel disease had about a 28% higher risk of Parkinson’s disease (PD) than that of matched controls in a large retrospective analysis of administrative health care claims.

But tumor necrosis factor (TNF) inhibitor therapy appeared to attenuate this risk, wrote Inga Peter, PhD, of Icahn School of Medicine at Mount Sinai, New York, and her associates. Patients with inflammatory bowel disease (IBD) who received TNF inhibitors were 78% less likely to develop PD than were those who did not (P = .03). “Reducing systemic inflammation in at-risk individuals may decrease the incidence of PD [Parkinson disease],” the researchers wrote. The study was published online April 23 in JAMA Neurology.

The researchers queried the Truven Health MarketScan database and the Medicare Supplemental Database for patients with IBD from 2000 through 2016. The databases included more than 170 million patients, of whom 144,018 had at least two IBD-related claims, at least 6 months of follow-up, and no baseline PD diagnosis. These patients were matched by age, sex, and treatment year with 720,090 individuals without IBD from the same databases.

A total of 1,796 patients had at least two recorded PD diagnoses and had filled at least one associated prescription, said the researchers. Based on this PD definition, patients with IBD developed PD at a 28% higher rate than that of matched controls (adjusted IRR, 1.28; 95% CI, 1.14 to 1.44; P less than .001).

Among the IBD patients, those receiving anti-TNF therapy developed about 0.08 cases of PD for every 1,000 person-years, versus 0.76 PD cases per 1,000 person-years in the group not receiving anti-TNF therapy. After adjustment for age, sex, and time at risk, anti-TNF therapy was associated with a 78% reduction in the incidence of PD among IBD patients (adjusted incidence rate ratio, 0.22; 95% confidence interval, 0.05-0.88; P = .03).

“In summary, we showed a potential clinical link between IBD and PD, supporting shared mechanisms involved in the pathogenesis of these diseases,” the researchers wrote. “Moreover, our data suggest that early exposure to anti-TNF therapy may reduce the risk of PD among patients with IBD, potentially owing to a reduction in systemic inflammation. These findings should be further assessed and confirmed by other studies.”

Dr. Peter received support from the Leona M. and Harry B. Helmsley Charitable Trust. AbbVie employed three coinvestigators. Two coinvestigators had other ties to Abbvie and Amgen.

SOURCE: Peter I et al. JAMA Neurol. 2018 Apr 23. doi: 10.1001/jamaneurol.2018.0605.

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