Management of disease-modifying therapies in multiple sclerosis and comorbid rheumatoid arthritis

Area of Science:

• Immunology
• Neurology
• Rheumatology

Background:

• Comorbid autoimmune disorders like rheumatoid arthritis (RA) are frequent in multiple sclerosis (MS) patients.
• Shared pathogenic pathways between MS and RA suggest potential therapeutic overlaps.
• The efficacy of disease-modifying therapies (DMTs) for MS in treating RA varies.

Purpose of the Study:

• To review the effects of MS-DMTs on both MS and RA, and vice versa.
• To identify suitable DMTs for patients with comorbid MS and RA.
• To assess the safety and efficacy of existing and investigational therapies.

Main Methods:

• A comprehensive literature review was conducted using PubMed.
• The review focused on approved and investigational DMTs for MS and RA.
• Effects on both conditions, as well as adverse events, were evaluated.

Main Results:

• Teriflunomide, anti-CD20 therapies, and cladribine demonstrated benefits for RA in MS patients.
• Type-I interferons and Bruton's tyrosine kinase (BTK) inhibitors showed limited efficacy for RA.
• BTK inhibitors were effective for certain MS forms, while secukinumab had limited effects in relapsing MS.
• No significant benefit was observed for abatacept in MS patients with RA; Janus kinase inhibitors and IL-6 receptor inhibitors lack trials.
• Adverse events, including RA exacerbation, were noted with dimethyl fumarate, alemtuzumab, and natalizumab.
• Tumor necrosis factor alpha (TNFα) inhibitors increased MS disease activity.

Conclusions:

• Teriflunomide and anti-CD20 therapies are recommended for moderate to highly active MS with comorbid RA.
• Cladribine can be considered as a treatment option.
• TNFα inhibitors are contraindicated in MS patients due to the risk of increased disease activity.