Grant: Doctoral Research Award: Canada Graduate Scholarships

Thanks to better understanding of the inflammatory process, tumor necrosis factor (TNF) (i.e., a protein in our body that causes inflammation) and its inhibitors (i.e., drugs that suppress the effect of TNF) were discovered. TNF inhibitors (TNFi) are widely used in patients with moderate to severe inflammatory rheumatic diseases (RD, like rheumatoid arthritis) or inflammatory bowel diseases (IBD, like ulcerative colitis and Crohn's disease). RD and IBD affect approximately 1 million Canadians in total. Even though TNFi are able to improve patients' quality of life, a number of case reports have linked taking TNFi medication to a higher risk of developing multiple sclerosis (MS). MS is a disease that can cause problems with vision, balance, muscle control, and other basic body functions. MS is also associated with a very high healthcare burden in Canada, as it shortens Canadians' life by 6 years, incurs $2 billion in healthcare costs annually, and is most often diagnosed in young adults aged 20 to 49 during critical years of work life. Nevertheless, this issue has not been thoroughly studied. To fill this gap, I will do the following: 1. Find out how common MS is among RD or IBD patients who used TNFi compared to those who did not use TNFi. 2. Find out if RD and IBD patients with longer use and higher dose of TNFi have a higher risk of developing MS. I will use administrative datasets from British Columbia, Alberta, Manitoba, and Saskatchewan, with information routinely collected during clinic, hospital, and pharmacy records. The datasets include all RD and IBD patients (120,000 and 70,000, respectively) who received medical care between 2000 and 2015 from four Canadian provinces. I will conduct the studies for RD and IBD, separately. Findings from this work will identify MS risk factors, potentially prevent MS cases, and will positively impact Canadian public health, global health and new drug discovery.