Study Associates Use of TNF Alpha Inhibitors in Crohn’s Disease with Increased Risk of MS

Dr. Jay Avasarala, professor of neurology and director of UK’s Multiple Sclerosis Clinic, and co-authors, conducted a retrospective study in which they evaluated approximately 96.5 million enrollees in a database. Mark Cornelison l UK Photo

LEXINGTON, Ky. (May 11, 2021) — Dr. Jay Avasarala, professor of neurology and director of the University of Kentucky’s Multiple Sclerosis Clinic, and co-authors, conducted a retrospective study in which they evaluated approximately 96.5 million enrollees in a database. More than 200,000 of the enrollees had inflammatory bowel disease (IBD). The research focused on looking at the effect of TNF-alpha inhibitors, biologic agents, used in IBD treatment on the probability of developing Multiple Sclerosis (MS).

Findings from the study were recently published in the journal Multiple Sclerosis and Related Disorders. In the article, Avasarala explains, “published literature indicates that IBD and MS patients have a 50% increased risk (bi-directional) of MS or IBD co-morbidity, respectively, with no apparent differences between patients with Crohn’s disease. The association between MS and IBD is strengthened by observations of an increased prevalence of IBD among MS patients compared to the general population. Another study published in 2005 noted the increased prevalence of MS, demyelination, and optic neuritis in patients with IBD.”

The recent work by Avasarala and his co-authors at UK found that those with IBD exposed to TNF-alpha inhibitors had a 43% increase in the incidence of MS compared to those with IBD but without the drug exposure. The team also found a statistically significant increase in the incidence of Crohn’s disease compared to those not exposed to the TNF-alpha inhibitor drugs. Crohn's disease is a type of IBD that causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

“To the best of my knowledge, this is the first time that the TNF-alpha inhibitor drugs have been shown to be associated with a decrease in the incidence of Parkinson's disease (Inga P, et al., JAMA Neurology, 2018) when used early in patients with inflammatory bowel disease but associated with an increased incidence of MS when TNF-alpha inhibitor drugs were used in the treatment of Crohn's disease,” said Dr. Avasarala. Taken together, the findings reveal interesting if divergent results.

Avasarala says he believes the biggest takeaway from their analysis is that the use of TNF-alpha inhibitors in IBD patients can be beneficial in reducing the incidence of Parkinson’s disease later in life but can also be associated with an increased incidence of Crohn’s disease.

Dr. Zain Guduru, Department of Neurology; Christopher McLouth, Ph.D., Department of Behavioral Sciences; Amanda Wilburn, Department of Neurology; Jeffery Talbert, Ph.D., biomedical informatics, Department of Pharmacy Practice and Science; Brent Sokola, Pharm.D; and Dr. Paige Sutton, Department of Neurology, contributed to the study and are cited in the published article.

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. 





The University of Kentucky is increasingly the first choice for students, faculty and staff to pursue their passions and their professional goals. In the last two years, Forbes has named UK among the best employers for diversity, and INSIGHT into Diversity recognized us as a Diversity Champion four years running. UK is ranked among the top 30 campuses in the nation for LGBTQ* inclusion and safety. UK has been judged a “Great College to Work for" three years in a row, and UK is among only 22 universities in the country on Forbes' list of "America's Best Employers."  We are ranked among the top 10 percent of public institutions for research expenditures — a tangible symbol of our breadth and depth as a university focused on discovery that changes lives and communities. And our patients know and appreciate the fact that UK HealthCare has been named the state’s top hospital for five straight years. Accolades and honors are great. But they are more important for what they represent: the idea that creating a community of belonging and commitment to excellence is how we honor our mission to be not simply the University of Kentucky, but the University for Kentucky.