Association of Anti-inflammatory Therapy Use with the Incidence of Parkinson’s Disease: A Person-Time Analysis Among Patients with Autoimmune Diseases
Jennifer Haas1, Michele Potashman2, Ambrish Pandit1, Dana Stafkey-Mailey3, Vladimir Coric2, Wolfgang Singer4, Gilbert L'Italien2
1Xcenda GmbH, Cencora Inc., 2Biohaven Pharmaceuticals, Inc., 3Cencora Inc., 4Mayo Clinic
Objective:
Investigate the correlation between Parkinson’s Disease (PD) occurrence and exposure to anti-inflammatory medications, specifically anti-tumor necrosis factor (anti-TNF) and anti-interleukin (IL)-17, in individuals diagnosed with autoimmune conditions (rheumatoid arthritis, ulcerative colitis, Crohn’s disease, ankylosing spondylitis, or psoriasis/psoriatic arthritis).
Background:
PD incidence is higher in autoimmune patients, necessitating further investigation of the impact of anti-inflammatory drug exposure.
Design/Methods:
In this retrospective cohort study, we leveraged data from the US Komodo Health claims database to identify individuals diagnosed with autoimmune diseases between 2015 and 2022. To assess the comparative risk of PD associated with exposure to anti-TNF/anti-IL-17 treatments, two patient cohorts were delineated: exposed to specified anti-inflammatory therapy and unexposed. Person-time incidence rates of PD were computed, and incidence rate ratios (IRRs) were derived for association analysis. Person-time incidence rates per 100 person-years (PY) across quintiles of anti-TNF/anti-IL-17 exposure were calculated.
Results:
Among 2,105,677 autoimmune patients, 114,082 received anti-TNF/anti-IL-17 treatment, while 1,991,595 remained untreated. PD incidence was 0.661 per 100-PY in the exposed cohort compared to 0.949 per 100-PY in the unexposed cohort. The IRR comparing the exposed to the unexposed was 0.696 (95% CI: 0.669, 0.724). PD incidence rates for anti-inflammatory drug recipients were: anti-TNF only - 0.665 (95% CI: 0.639, 0.692), and anti-IL-17 only - 0.519 (95% CI: 0.412, 0.645. The IRR between anti-IL-17 and anti-TNF therapy indicated that patients treated with anti-IL-17 had a lower risk of developing PD (0.781 [95% CI: 0.626, 0.975)]. Analysis of person-time incidence rates revealed a potential treatment-response relationship, with an incidence rate of 5.295 (95% CI: 4.937, 5.673) in the lowest exposure quintile and 0.158 per 100-PY (95% CI: 0.139, 0.179) in the highest exposure quintile.
Conclusions:
Our findings suggest that anti-TNF/anti-IL-17 treatment in patients with autoimmune disease reduces PD incidence, indicating that the mitigation of systemic inflammation could potentially lower the risk of developing PD.