Grant: Project Grant

Tumor necrosis factor inhibitors (TNFi) are a relatively new class of medications used by patients with a rheumatic disease (RD) and inflammatory bowel disease (IBD) with moderate to severe disease. Case reports and two epidemiologic studies have alluded to a potential risk of multiple sclerosis (MS) with in patients with RD and IBD who use TNFi. However, these studies have shown conflicting results mainly due to limitations in their study methodology including having small sample sizes which prevented the study to convincingly show whether TNFi increases MS risk. The incidence of RD and IBD is increasing in Canada and United States. This means that the number of patients with RD and IBD on TNFi therapy is increasing possibly putting them at an unnecessary risk for developing MS. Our study will be the first to identify a possible modifiable risk factor (TNFi use) for MS in a population of patients already afflicted with a chronic disease and a high burden of illness (RD or IBD). In case our study identifies an increase in the risk of MS with TNFi use, this study can quantify the potential risk of MS with TNFi and allow for clinicians to better inform this risk to their patients. The results of this study can also inform policy makers in drug regulatory agencies such as the FDA and Health Canada to issue global warning on this potential risk.