Targeted Disease-modifying antirheumatic drugs (DMARDs) treatment shows a 30% reduced risk of dementia, suggesting potential for dementia prevention in high-risk RA patients.

To discover the link between DMARDs therapy for rheumatoid arthritis with the risk of incident dementia.

PubMed, EMBASE and Cochrane Library were explored to consider relevant studies about the connection of dementia with DMARDs in rheumatoid arthritis. Summary statistics included pooled risk ratios (RRs) with 95% confidence intervals (CIs). GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to estimate the evidence certainty.

A total of 940 442 patients with rheumatoid arthritis were included (from 14 relevant observational studies). The bDMARDs therapy was linked with a significant reduction in dementia risk as compared with conventional synthetic DMARDs (RR 0.76, 95% CI 0.72 to 0.80), details below (Table 1):

Significant subgroup differences were perceived among different TNF inhibitors (RR 0.58 [95% CI 0.53 to 0.65] for Etanercept, 0.65 [95% CI 0.59 to 0.72] for Adalimumab, 0.80 [95% CI 0.72 to 0.88] for Infliximab; p-value = 0.002). However, there was no significant impact on dementia incidence among patients receiving conventional synthetic DMARDs overall, Methotrexate, or Hydroxychloroquine, compared to non-users or those undergoing investigative treatment. The exception was Sulfasalazine, which displayed a slightly augmented dementia risk (RR 1.27, 95% CI 1.06 to 1.50).

Biological DMARDs therapy was found to be correlated with reduced dementia risk. Future clinical trials on TNF inhibitors are essential for a better understanding of their neuroprotective capacities.