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Lewis JE, McDaniel HR, Woolger JM, Anzola E, Kraft G. The Characterization of the Th1/Th2 Ratio in Multiple Sclerosis Patients and its Response to a Dietary Supplement Regimen. J Diet Suppl 2024:1-20. [PMID: 39140744 DOI: 10.1080/19390211.2024.2386259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a debilitating neurodegenerative disease affecting the central nervous system, causing disability and life-threatening complications. The interplay between immune cells and signaling pathways is a topic for investigating novel therapies. Past research has shown how the Th1/Th2 ratio plays a key role in the pathogenesis of MS lesions. Modulating the Th1/Th2 ratios with an efficacious dietary supplement may improve some of the consequences of MS. METHODS Participants (n = 15) diagnosed with MS for an average of 12.4 years (standard deviation = 7.4; range = 2, 25) were enrolled in a clinical trial in which they consumed a dietary supplement regimen daily for 12 months. Venous blood was drawn at baseline and 12-month follow-up and peripheral blood mononuclear cells, cytokines, and growth factors were quantified. Infections, physical functioning, and quality of life were also assessed at baseline and 12 months. RESULTS The IL-2/IL-10 and IFN-γ/IL-10 ratios were significantly higher than those of the healthy adults, and while only IFN-γ/IL-10 increased significantly at 12 months, all ratios other than IFN-γ/TNF-α increased over the course of the intervention. The decrease in yeast infections was inversely correlated with IL-2/TNF-α and IFN-γ/TNF-α. Significant improvements in physical functioning and quality of life correlated with changes in the Th1/Th2 ratios in response to the dietary supplement regimen. CONCLUSIONS The results show that dietary supplementation somewhat impacted the Th1/Th2 ratios over the course of the intervention (toward more Th1 dominance), and those changes were related to various clinical improvements of the participants' symptoms in cognitive, motor, and psychosocial dimensions.
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Affiliation(s)
| | | | | | - Enrique Anzola
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Garrett Kraft
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Collongues N, Durand-Dubief F, Lebrun-Frenay C, Audoin B, Ayrignac X, Bensa C, Bigaut K, Bourre B, Carra-Dallière C, Ciron J, Defer G, Kwiatkowski A, Leray E, Maillart E, Marignier R, Mathey G, Morel N, Thouvenot E, Zéphir H, Boucher J, Boutière C, Branger P, Da Silva A, Demortière S, Guillaume M, Hebant B, Januel E, Kerbrat A, Manchon E, Moisset X, Montcuquet A, Pierret C, Pique J, Poupart J, Prunis C, Roux T, Schmitt P, Androdias G, Cohen M. Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society. Mult Scler 2024; 30:899-924. [PMID: 38357870 DOI: 10.1177/13524585231223880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Epidemiological data reveal that 45% of persons with multiple sclerosis (PwMS) in France are more than 50 years. This population more than 50 is more susceptible to cancer, and this risk may be increased by frequent use of immunosuppressive drugs. Consequently, concerns have arisen about the potential increased risk of cancer in PwMS and how patients should be screened and managed in terms of cancer risk. OBJECTIVE To develop evidence-based recommendations to manage the coexistence of cancer and multiple sclerosis (MS). METHODS The French Group for Recommendations in MS collected articles from PubMed and university databases covering the period January 1975 through June 2022. The RAND/UCLA method was employed to achieve formal consensus. MS experts comprehensively reviewed the full-text articles and developed the initial recommendations. A group of multidisciplinary health care specialists then validated the final proposal. RESULTS Five key questions were addressed, encompassing various topics such as cancer screening before or after initiating a disease-modifying therapy (DMT), appropriate management of MS in the context of cancer, recommended follow-up for cancer in patients receiving a DMT, and the potential reintroduction of a DMT after initial cancer treatment. A strong consensus was reached for all 31 recommendations. CONCLUSION These recommendations propose a strategic approach to managing cancer risk in PwMS.
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Affiliation(s)
- Nicolas Collongues
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
- Center for Clinical Investigation, INSERM U1434, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
- Department of Pharmacology, Addictology, Toxicology, and Therapeutics, Strasbourg University, Strasbourg, France
| | - Françoise Durand-Dubief
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Christine Lebrun-Frenay
- Department of Neurology, CHU Nice, Nice, France
- Université Côte d'Azur, UMR2CA-URRIS, Nice, France
| | - Bertrand Audoin
- Department of Neurology, CRMBM, APHM, Aix-Marseille University, Marseille, France
| | - Xavier Ayrignac
- Department of Neurology, Montpellier University Hospital, Montpellier, France
- University of Montpellier, Montpellier, France
- INM, INSERM, Montpellier, France
| | - Caroline Bensa
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kévin Bigaut
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | | | | | - Jonathan Ciron
- CHU de Toulouse, CRC-SEP, Department of Neurology, Toulouse, France
- Université Toulouse III, Infinity, INSERM UMR1291-CNRS UMR5051, Toulouse, France
| | - Gilles Defer
- Department of Neurology, Caen University Hospital, Caen, France
| | - Arnaud Kwiatkowski
- Department of Neurology, Lille Catholic University, Lille Catholic Hospitals, Lille, France
| | - Emmanuelle Leray
- Université de Rennes, EHESP, CNRS, INSERM, ARENES-UMR 6051, RSMS-U1309, Rennes, France
| | | | - Romain Marignier
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Nathalie Morel
- Service de Neurologie, Centre Hospitalier Annecy Genevois, Epagny-Metz-Tessy, France
| | - Eric Thouvenot
- Service de Neurologie, CHU de Nîmes, Nîmes, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Hélène Zéphir
- University of Lille, INSERM U1172, CHU de Lille, Lille, France
| | - Julie Boucher
- Department of Neurology, CHU de Lille, Lille, France
| | - Clémence Boutière
- Department of Neurology, University Hospital of Marseille, Marseille, France
| | - Pierre Branger
- Service de Neurologie, CHU de Caen Normandie, Caen, France
| | - Angélique Da Silva
- Breast Cancer Unit, Centre François Baclesse, Institut Normand du Sein, Caen, France
| | - Sarah Demortière
- Department of Neurology, CRMBM, APHM, Aix-Marseille University, Marseille, France
| | | | | | - Edouard Januel
- Sorbonne Université, Paris, France/Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Paris, France
- Département de Neurologie, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Anne Kerbrat
- Service de Neurologie, CHU de Rennes, France
- EMPENN U1228, INSERM-INRIA, Rennes, France
| | - Eric Manchon
- Service de Neurologie, Centre Hospitalier de Gonesse, Gonesse, France
| | - Xavier Moisset
- Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, Neuro-Dol, Clermont-Ferrand, France
| | | | - Chloé Pierret
- Université de Rennes, EHESP, CNRS, INSERM, ARENES-UMR 6051, RSMS U-1309, Rennes, France
| | - Julie Pique
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Julien Poupart
- Department of Neurology and U995-LIRIC-Lille Inflammation Research International Center, INSERM, University of Lille, CHU Lille, Lille, France
| | - Chloé Prunis
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Thomas Roux
- Hôpital La Pitié-Salpêtrière, Service de Neurologie, Paris, France
- CRC-SEP Paris. Centre des maladies inflammatoires rares du cerveau et de la moelle de l'enfant et de l'adulte (Mircem)
| | | | - Géraldine Androdias
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Service de Neurologie, Hôpital Neurologique Pierre Wertheimer, Bron, France
- Clinique de la Sauvegarde-Ramsay Santé, Lyon, France
| | - Mikael Cohen
- Department of Neurology, CHU Nice, Nice, France/Université Côte d'Azur, UMR2CA-URRIS, Nice, France
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Ng HS, Zhu F, Zhao Y, Yao S, Lu X, Ekuma O, Evans C, Fisk JD, Marrie RA, Tremlett H. Adverse Events Associated With Disease-Modifying Drugs for Multiple Sclerosis: A Multiregional Population-Based Study. Neurology 2024; 102:e208006. [PMID: 38181306 PMCID: PMC11097763 DOI: 10.1212/wnl.0000000000208006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/27/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES It is not possible to fully establish the safety of a disease-modifying drug (DMD) for multiple sclerosis (MS) from randomized controlled trials as only very common adverse events occurring over the short-term can be captured, and the quality of reporting has been variable. We examined the relationship between the DMDs for MS and potential adverse events in a multiregion population-based study. METHODS We identified people with MS using linked administrative health data from 4 Canadian provinces. MS cases were followed from the most recent of first MS or related demyelinating disease event on January 1, 1996, until the earliest of emigration, death, or December 31, 2017. DMD exposure primarily comprised β-interferon, glatiramer acetate, natalizumab, fingolimod, dimethyl fumarate, teriflunomide, and alemtuzumab. We examined associations between DMD exposure and infection-related hospitalizations and physician visits using recurrent events proportional means models and between DMD exposure and 15 broad categories of incident adverse events using stratified multivariate Cox proportional hazard models. RESULTS We identified 35,894 people with MS. While virtually all DMDs were associated with a 42%-61% lower risk of infection-related hospitalizations, there was a modest increase in infection-related physician visits by 10%-33% for select DMDs. For incident adverse events, most elevated risks involved a second-generation DMD, with alemtuzumab's hazard of thyroid disorders being 19.42 (95% CI 9.29-36.51), hypertension 4.96 (95% CI 1.78-13.84), and cardiovascular disease 3.72 (95% CI 2.12-6.53). Natalizumab's highest risk was for cardiovascular disease (adjusted hazard ratio [aHR] 1.61; 95% CI 1.24-2.10). For the oral DMDs, fingolimod was associated with higher hazards of cerebrovascular (aHR 2.04; 95% CI 1.27-3.30) and ischemic heart diseases (aHR 1.64; 95% CI 1.10-2.44) and hypertension (aHR 1.73; 95% CI 1.30-2.31); teriflunomide with higher hazards of thyroid disorders (aHR 2.30; 95% CI 1.11-4.74), chronic liver disease (aHR 1.94; 95% CI 1.19-3.18), hypertension (aHR 1.76; 95% CI 1.32-2.37), and hyperlipidemia (aHR 1.61; 95% CI 1.07-2.44); and from complementary analyses (in 1 province), dimethyl fumarate with acute liver injury (aHR 6.55; 95% CI 1.96-21.87). DISCUSSION Our study provides an extensive safety profile of several different DMDs used to treat MS in the real-world setting. Our findings not only complement those observed in short-term clinical trials but also provide new insights that help inform the risk-benefit profile of the DMDs used to treat MS in clinical practice. The results of this study highlight the continued need for long-term, independent safety studies of the DMDs used to treat MS. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for patients with MS, while DMD exposure reduces the risk of infection-related hospitalizations, there are increased risks of infection-related physician visits and incident adverse events for select DMDs.
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Affiliation(s)
- Huah Shin Ng
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Feng Zhu
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yinshan Zhao
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shenzhen Yao
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Xinya Lu
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Division of Neurology (H.S.N., F.Z., Y.Z., H.T.), Department of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Flinders Health and Medical Research Institute (H.S.N.), College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Pharmacy (H.S.N.), Northern and Southern Adelaide Local Health Networks, Australia; College of Pharmacy and Nutrition (S.Y., C.E.), University of Saskatchewan; Saskatchewan Health Quality Council (S.Y., X.L.), Saskatoon; Department of Community Health Sciences (O.E.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Greenfield J, Metz LM, Khakban A, Llorian ER, Michaux KD, Traboulsee A, Oh J, Smyth P, Lynd LD, Bulloch AGM, Williams JVA, Patten SB. Cancer risk, disease-modifying therapy, and age in multiple sclerosis: A retrospective population-based cohort study. Mult Scler Relat Disord 2023; 80:105091. [PMID: 37924714 DOI: 10.1016/j.msard.2023.105091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Long-term population-based safety studies are needed to investigate cancer outcomes in people with multiple sclerosis (MS) treated with modern disease-modifying therapy (DMT). OBJECTIVES To investigate if exposure to DMT increases the risk of invasive cancer in MS. METHODS We used population-based administrative health data from Alberta, Canada between 2008 and 2018. DMT exposure was defined in two ways: first as exposure to any DMT, and second by DMT type (modulating, sequestering, depleting). Study outcome was time to first diagnosis of invasive cancer. Cancer risk was compared to the general population using standardized incidence ratios (SIRs) and to the unexposed MS cases using hazard ratios (HRs). RESULTS The analysis included 14,313 MS cases: 5,801 (40.5 %) were exposed to DMT. Median (interquartile range) follow-up was 8.4 (4.3, 10.4) years. Compared to the general population, there was no difference in cancer risk for the overall MS population (SIR: 0.94, 95 % confidence interval [CI]: 0.87, 1.02) or the DMT-exposed MS cases (SIR: 0.89; 95 % CI: 0.75, 1.05). Compared to unexposed MS cases, we found an interaction with age for exposure to any DMT (p = 0.001) and modulating DMT (p = 0.001), indicating that a difference in the risk of cancer associated with DMT depends on age. Cancer risk was not associated with exposure to sequestering DMT (HR: 1.28, 95 % CI: 0.78, 2.08) or depleting DMT (HR: 2.29, 95 % CI: 0.86, 6.14). CONCLUSIONS Cancer risk for MS patients was similar to the general population. In the MS population, the age-dependent effect of DMT for cancer risk suggests a higher risk of cancer with age 62 or older and a protective effect at younger age. Further investigation is required to clarify whether the interaction between DMT exposure and age is a causal effect.
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Affiliation(s)
- Jamie Greenfield
- Department of Clinical Neurosciences, University of Calgary, 9th Floor South Tower, Foothills Medical centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada.
| | - Luanne M Metz
- Department of Clinical Neurosciences, University of Calgary, 9th Floor South Tower, Foothills Medical centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada
| | - Amir Khakban
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kristina D Michaux
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jeanne V A Williams
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Thakolwiboon S, Mills EA, Yang J, Doty J, Belkin MI, Cho T, Schultz C, Mao-Draayer Y. Immunosenescence and multiple sclerosis: inflammaging for prognosis and therapeutic consideration. FRONTIERS IN AGING 2023; 4:1234572. [PMID: 37900152 PMCID: PMC10603254 DOI: 10.3389/fragi.2023.1234572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023]
Abstract
Aging is associated with a progressive decline of innate and adaptive immune responses, called immunosenescence. This phenomenon links to different multiple sclerosis (MS) disease courses among different age groups. While clinical relapse and active demyelination are mainly related to the altered adaptive immunity, including invasion of T- and B-lymphocytes, impairment of innate immune cell (e.g., microglia, astrocyte) function is the main contributor to disability progression and neurodegeneration. Most patients with MS manifest the relapsing-remitting phenotype at a younger age, while progressive phenotypes are mainly seen in older patients. Current disease-modifying therapies (DMTs) primarily targeting adaptive immunity are less efficacious in older patients, suggesting that immunosenescence plays a role in treatment response. This review summarizes the recent immune mechanistic studies regarding immunosenescence in patients with MS and discusses the clinical implications of these findings.
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Affiliation(s)
| | - Elizabeth A. Mills
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer Yang
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan Doty
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, United States
| | - Martin I. Belkin
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, United States
| | - Thomas Cho
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Charles Schultz
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, United States
- Autoimmune Center of Excellence, University of Michigan, Ann Arbor, MI, United States
- Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan, Ann Arbor, MI, United States
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Macaron G, Larochelle C, Arbour N, Galmard M, Girard JM, Prat A, Duquette P. Impact of aging on treatment considerations for multiple sclerosis patients. Front Neurol 2023; 14:1197212. [PMID: 37483447 PMCID: PMC10361071 DOI: 10.3389/fneur.2023.1197212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/18/2023] [Indexed: 07/25/2023] Open
Abstract
With a rapidly aging global population and improvement of outcomes with newer multiple sclerosis (MS)-specific disease-modifying therapies (DMTs), the epidemiology of MS has shifted to an older than previously described population, with a peak prevalence of the disease seen in the 55-65 years age group. Changes in the pathophysiology of MS appear to be age-dependent. Several studies have identified a consistent phase of disability worsening around the fifth decade of life. The latter appears to be independent of prior disease duration and inflammatory activity and concomitant to pathological changes from acute focal active demyelination to chronic smoldering plaques, slow-expanding lesions, and compartmentalized inflammation within the central nervous system (CNS). On the other hand, decreased CNS tissue reserve and poorer remyelinating capacity with aging lead to loss of relapse recovery potential. Aging with MS may imply longer exposure to DMTs, although treatment efficacy in patients >55 years has not been evaluated in pivotal randomized controlled trials and appears to decrease with age. Older individuals are more prone to adverse effects of DMTs, an important aspect of treatment individualization. Aging with MS also implies a higher global burden of comorbid illnesses that contribute to overall impairments and represent a crucial confounder in interpreting clinical worsening. Discontinuation of DMTs after age 55, when no evidence of clinical or radiological activity is detected, is currently under the spotlight. In this review, we will discuss the impact of aging on MS pathobiology, the effect of comorbidities and other confounders on clinical worsening, and focus on current therapeutic considerations in this age group.
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Affiliation(s)
- Gabrielle Macaron
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Faculté de Médecine, Université Saint-Joseph de Beyrouth, Beirut, Lebanon
| | - Catherine Larochelle
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Nathalie Arbour
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Manon Galmard
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Jean Marc Girard
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Alexandre Prat
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Pierre Duquette
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
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Bridge F, Brotherton JML, Foong Y, Butzkueven H, Jokubaitis VG, Van der Walt A. Risk of cervical pre-cancer and cancer in women with multiple sclerosis exposed to high efficacy disease modifying therapies. Front Neurol 2023; 14:1119660. [PMID: 36846149 PMCID: PMC9950275 DOI: 10.3389/fneur.2023.1119660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
There is a growing need to better understand the risk of malignancy in the multiple sclerosis (MS) population, particularly given the relatively recent and widespread introduction of immunomodulating disease modifying therapies (DMTs). Multiple sclerosis disproportionately affects women, and the risk of gynecological malignancies, specifically cervical pre-cancer and cancer, are of particular concern. The causal relationship between persistent human papillomavirus (HPV) infection and cervical cancer has been definitively established. To date, there is limited data on the effect of MS DMTs on the risk of persistent HPV infection and subsequent progression to cervical pre-cancer and cancer. This review evaluates the risk of cervical pre-cancer and cancer in women with MS, including the risk conferred by DMTs. We examine additional factors, specific to the MS population, that alter the risk of developing cervical cancer including participation in HPV vaccination and cervical screening programs.
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Affiliation(s)
- Francesca Bridge
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia,*Correspondence: Francesca Bridge ✉
| | - Julia M. L. Brotherton
- Australian Centre for the Prevention of Cervical Cancer (Formerly Victorian Cytology Service), Carlton South, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Yi Foong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia,Department of Neurosciences, Eastern Health, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Vilija G. Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Anneke Van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
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8
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Maric G, Pekmezovic T, Mesaros S, Tamas O, Veselinovic N, Budimkic Stefanovic M, Jovanovic A, Drulovic J. Occurrence of malignant diseases in patients with multiple sclerosis: population-based MS Registry data. Neurol Sci 2022; 43:6839-6846. [DOI: 10.1007/s10072-022-06362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
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9
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Zhang M, Wang Y, Wang Y, Bai Y, Gu D. Association Between Systemic Lupus Erythematosus and Cancer Morbidity and Mortality: Findings From Cohort Studies. Front Oncol 2022; 12:860794. [PMID: 35600353 PMCID: PMC9115099 DOI: 10.3389/fonc.2022.860794] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background Observational studies suggested that systemic lupus erythematosus (SLE) might be associated with increased cancer incidence and cancer-related death, however, the results are inconsistent. We aim to comprehensively estimate the causal relationships between SLE and cancer morbidity and mortality using a meta-analysis of cohort studies and Mendelian randomization. Methods A systematic search was conducted using PubMed to identify cohort studies published before January 21, 2021. Meta-analysis was performed to calculate relative risk (RR) and corresponding 95% confidence intervals (CI). In addition, we further evaluated the potentially causal relationships identified by cohort studies using two-sample Mendelian randomization. Results A total of 48 cohort studies involving 247,575 patients were included. We performed 31 main meta-analysis to assess the cancer risk and three meta-analyses to evaluate cancer mortality in SLE patients. Through meta-analyses, we observed an increased risk of overall cancer (RR=1.62, 95%CI, 1.47-1.79, P<0.001) and cancer-related death (RR=1.52, 95%CI, 1.36-1.70, P<0.001) in patients with SLE. Subgroup analysis by site-specific cancer showed that SLE was a risk factor for 17 site-specific cancers, including six digestive cancers (esophagus, colon, anus, hepatobiliary, liver, pancreatic), five hematologic cancers (lymphoma, Hodgkin's lymphoma, non-Hodgkin lymphoma, leukemia, multiple myeloma), as well as cancer in lung, larynx, cervical, vagina/vulva, renal, bladder, skin, and thyroid. In addition, further mendelian randomization analysis verified a weakly association between genetically predisposed SLE and lymphoma risk (odds ratio=1.0004, P=0.0035). Conclusions Findings from our study suggest an important role of SLE in carcinogenesis, especially for lymphoma. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, CRD42021243635.
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Affiliation(s)
- Min Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yizhou Wang
- Department of Pathology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Yutong Wang
- Department of Epidemiology and Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ye Bai
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Dongqing Gu
- Department of Infectious Diseases, First Affiliated Hospital, Army Medical University, Chongqing, China
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10
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Papadopoulos D, Gklinos P, Psarros G, Drellia K, Delicha EM, Friede T, Mitsikostas DD, Nicholas RS. Disease-modifying treatments for multiple sclerosis have not affected the incidence of neoplasms in clinical trials over 3 decades: a meta-analysis with meta-regression. J Neurol 2022; 269:3226-3237. [DOI: 10.1007/s00415-021-10932-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
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11
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Nørgaard M, Veres K, Sellebjerg FT, Svingel LS, Foch C, Boutmy E, Sabidó M, Magyari M. Incidence of malignancy in multiple sclerosis: A cohort study in the Danish Multiple Sclerosis Registry. Mult Scler J Exp Transl Clin 2021; 7:20552173211053939. [PMID: 34840804 PMCID: PMC8613897 DOI: 10.1177/20552173211053939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The association between multiple sclerosis and malignancy is controversial and a current appraisal is needed. Objective To determine the incidence of malignancy in patients with multiple sclerosis compared with the general population and in relation to disease-modifying therapy. Methods Patients with multiple sclerosis (1995 – 2015) were matched by birth year and sex to individuals without multiple sclerosis in the general population. Patients with multiple sclerosis initiating disease-modifying therapy were evaluated using landmark period analysis. Malignancy risk was assessed by incidence rates, incidence rate ratios, and standardised incidence ratios. Results The standardised incidence ratio of any malignancy (excluding non-melanoma skin cancer) in patients with multiple sclerosis (n = 10,557) was 0.96 (95% CI 0.88 – 1.06), and there was no increased incidence of specific malignancy types compared with the general population cohort (n = 103,761). At the 48-month landmark period, the age-adjusted incidence per 100,000 person-years of any malignancy (excluding non-melanoma skin cancer) was 436.7 (95% CI 361.0 – 512.4) in patients newly treated with immunomodulator-only and 675.1 (95% CI 130.4 – 1219.9) in patients newly treated with immunosuppressant-only. Conclusions There was no increased incidence of malignancy overall or by type in patients with multiple sclerosis compared neither with the general population nor in relation to disease-modifying therapy.
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Affiliation(s)
- Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Finn T Sellebjerg
- The Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Denmark
| | - Lise S Svingel
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | | | | | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark
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12
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Dolladille C, Chrétien B, Peyro-Saint-Paul L, Alexandre J, Dejardin O, Fedrizzi S, Defer G. Association Between Disease-Modifying Therapies Prescribed to Persons with Multiple Sclerosis and Cancer: a WHO Pharmacovigilance Database Analysis. Neurotherapeutics 2021; 18:1657-1664. [PMID: 34231126 PMCID: PMC8608969 DOI: 10.1007/s13311-021-01073-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/04/2023] Open
Abstract
The risk of cancer associated with persons with multiple sclerosis (pwMS) prescribed with disease modifying therapies (DMTs) is not well established. This observational, cross-sectional, pharmacovigilance cohort study examined individual case safety reports from the World Health Organization database: VigiBase®. All consecutive reports of DMTs prescribed to pwMS (alemtuzumab, dimethyl fumarate, fingolimod, glatiramer acetate, interferon-β, natalizumab, ocrelizumab, and teriflunomide), and their serious adverse event cases were eligible, excluding those reporting immunosuppressant DMTs used as anticancer therapies. The primary outcome was the multivariate odds ratio of cancer reporting (r-OR) for DMTs prescribed to pwMS after imputation of missing data. There were 5966 cancer cases from 240,993 reports of DMTs prescribed to pwMS. After adjustments on age, sex, and geographical region, natalizumab (r-OR 1.74, 95% CI 1.63-1.87), interferon-β (r-OR 1.39, 95% CI 1.30-1.49), dimethyl fumarate (r-OR 1.35, 95% CI 1.25-1.46), and fingolimod (r-OR 1.15, 95% CI 1.06-1.24) were significantly associated with a greater cancer reporting, whereas alemtuzumab, glatiramer acetate, ocrelizumab, and teriflunomide were not, in the disproportionality analysis. As exploratory analyses, upper aerodigestive tract, breast, urinary including the male genitourinary tract, and nervous system cancers were associated with natalizumab, interferon-β, and dimethyl fumarate. Fingolimod was only associated with skin cancer types. Cancer cases reporting these four DMTs prescribed to pwMS were younger in age than for non-pwMS drugs in the VigiBase® (p < 0.0001). A close and regular cancer screening in pwMS treated with natalizumab, interferon-β, dimethyl fumarate, and fingolimod may be warranted, even for persons at a younger age. Trial Registration NCT04237337.
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Affiliation(s)
- Charles Dolladille
- Department of Pharmacology, CHU de Caen, 14000, Caen, France.
- Medical School, Electrophysiologie Et Imagerie Des Lesions D Ischemie Reperfusion Myocardique, Université Caen Normandie, EA 4650, Signalisation, 14000, Caen, France.
| | - Basile Chrétien
- Department of Pharmacology, CHU de Caen, 14000, Caen, France
| | | | - Joachim Alexandre
- Department of Pharmacology, CHU de Caen, 14000, Caen, France
- Medical School, Electrophysiologie Et Imagerie Des Lesions D Ischemie Reperfusion Myocardique, Université Caen Normandie, EA 4650, Signalisation, 14000, Caen, France
| | - Olivier Dejardin
- ANTICIPE U1086, Ligue Contre Le Cancer Team, Centre François Baclesse, INSERM-University of Caen Normandy, Caen, France
| | - Sophie Fedrizzi
- Department of Pharmacology, CHU de Caen, 14000, Caen, France
| | - Gilles Defer
- MS Expert Centre Department of Neurology, CHU de Caen, 14000, Caen, France
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13
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Stamatellos VP, Siafis S, Papazisis G. Disease-modifying agents for multiple sclerosis and the risk for reporting cancer: A disproportionality analysis using the US Food and Drug Administration Adverse Event Reporting System database. Br J Clin Pharmacol 2021; 87:4769-4779. [PMID: 33998034 DOI: 10.1111/bcp.14916] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 11/27/2022] Open
Abstract
AIM While the efficacy of disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) is established, little is known about their long-term safety. Cancer-risk after DMT use remains unclear. This study aimed to investigate whether the prescription of DMTs for patients with MS increases the risk of reporting cancer. METHODS Data from the Food and Drug Administration Adverse Event Reporting System were extracted from 2004 to 2020. After data cleaning, the crude and adjusted reported odds ratios (cROR and aROR) for cancer were calculated for DMTs with Interferon beta-1a as the reference drug. Sensitivity analyses investigated the group of reports with multiple registered DMTs, the effect of indication restriction and the results when using the rest of the DMTs as reference. RESULTS For malignant tumours, aROR (95% confidence interval [CI]) values were Cladribine 0.46 (0.18-0.95), Dimethyl fumarate 0.30 (0.27-0.34), Fingolimod 0.61 (0.53-0.70), Glatiramer 0.50 (0.43-0.58), Alemtuzumab 0.84 (0.64-1.08), Interferon beta-1b 0.49 (0.42-0.56), Natalizumab 0.36 (0.34-0.39), Ocrelizumab 0.48 (0.29-0.74), Peginterferon beta-1a 0.35 (0.26-0.48), Siponimod 0.89 (0.47-1.54) and Teriflunomide 0.25(0.21-0.30) adjusted to age, gender and concomitant medications. In the sensitivity analysis, when the rest of the drugs were used as a reference, Interferon beta-1a and Peginterferon beta-1a had aROR (95% CI) 2.60 (2.47-2.74, P < .001) and Alemtuzumab had aROR 1.47 (1.13-1.88, I = .003). CONCLUSIONS No safety signal for increased cancer risk was detected among the approved DMTs. A potential safety signal detected in the sensitivity analysis concerning Interferon beta-1a and Alemtuzumab requires further evaluation with more robust evidence.
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Affiliation(s)
| | - Spyridon Siafis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Cancer risk for multiple sclerosis patients treated with azathioprine and disease-modifying therapies: an Italian observational study. Neurol Sci 2021; 42:5157-5163. [PMID: 33791892 DOI: 10.1007/s10072-021-05216-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The risk of malignancy associated with sequential disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) is uncertain. The aim of this study was to analyze the risk of cancer in patients with MS treated with azathioprine (AZA) and the influence of sequential DMTs on the risk. METHOD We retrospectively enrolled a cohort of AZA-treated MS patients followed in two Italian centers from 1987 to 2019. The ratio between observed and expected cancers in the Italian general population was calculated as standardized incidence ratio (SIR). Associations between AZA and DMTs and cancer were estimated by Cox proportional hazards model. RESULTS We identified 500 AZA-treated MS patients, followed for a median time of 9.7 (0.1-45.7) years: 61.8% of them were treated with DMTs. We found 22 cases of cancer (4.4%). The SIR was 1.14 (95% CI 0.98-1.29), not significantly increased in comparison with the general population. However, the risk was significantly higher in the quintiles of age 32-45, SIR 1.21 (95% CI 1.21-1.42), and 46-51, SIR 1.11 (95% CI 1.11-1.32) than in older cases. Age at AZA treatment onset was the only covariate significantly related to cancer incidence (HR = 1.049, 95% CI 1.007-1.093). The exposure to other DMTs did not modify the risk. CONCLUSION The risk of malignancy in MS patients after AZA was similar to that of the general population and did not change with other DMTs sequential treatments. The increased risk in the younger ages should be considered in treatment assessment.
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Ge F, Huo Z, Li C, Wang R, Wang R, Liu Y, Chen J, Lu Y, Wen Y, Jiang Y, Peng H, Wu X, Liang H, He J, Liang W. Lung cancer risk in patients with multiple sclerosis: a Mendelian randomization analysis. Mult Scler Relat Disord 2021; 51:102927. [PMID: 33812221 DOI: 10.1016/j.msard.2021.102927] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The relationship of multiple sclerosis (MS) with lung cancer is under debate. Conventional observational studies have reported conflicting findings, but such studies are susceptible to confounding and reverse causation. With a Mendelian Randomization approach, we were able to evaluate the causality between MS and lung cancer. METHODS According to published genome-wide association studies (GWASs), we obtained 35 MS-related single-nucleotide polymorphisms, which were used as instrumental variables in our study. Summary data of individual-level genetic information were obtained from the International Lung Cancer Consortium (ILCCO), with a total of 15,861 controls and 11,348 cases; the latter is composed of patients with lung adenocarcinoma and squamous cell lung cancer. The inverse variance-weighted method was applied to estimate the causation between MS and lung cancer. To further evaluate the pleiotropy, the MR-Egger and Weighted median methods were implemented. RESULTS The results of MR analysis suggested a causal effect of MS on lung cancer incidence, with evidence of an increased risk for overall lung cancer [odds ratio (OR): 1.0648; 95% confidence interval (CI): 1.0163-1.1156; p = 0.0082]. However, subgroup analyses showed no significant causal relationships between MS and lung adenocarcinoma (OR = 1.0716; 95% CI 0.9840-1.1671, p = 0.1119) and squamous cell lung cancer (OR = 1.0284; 95% CI 0.9575-1.1045, p = 0.4424). In addition, no pleiotropy was found in our study. CONCLUSION Our study indicated that MS is a causal risk factor in the development of lung cancer. Further work is needed to elucidate the potential mechanisms.
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Affiliation(s)
- Fan Ge
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Zhenyu Huo
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Runchen Wang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Rui Wang
- Department of Clinical Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yeling Liu
- Department of Clinical Medicine, Third Clinical School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Jiana Chen
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yi Lu
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yaokai Wen
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yu Jiang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Haoxin Peng
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Xiangrong Wu
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, 511436, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China; Department of Oncology, the First People's Hospital of Zhaoqing, Zhaoqing, 526000, China.
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Jakimovski D, Eckert SP, Zivadinov R, Weinstock-Guttman B. Considering patient age when treating multiple sclerosis across the adult lifespan. Expert Rev Neurother 2021; 21:353-364. [PMID: 33595379 DOI: 10.1080/14737175.2021.1886082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The successful development of anti-inflammatory disease-modifying treatments (DMT) significantly improved disease outcomes and longevity of persons with multiple sclerosis (pwMS). However, the shift toward an elderly MS population has resulted with new concerns regarding DMT efficacy and safety.Areas covered: This review summarizes the evidence of an age-based decrease in the efficacy of MS DMTs and increase in pharmacovigilance concerns. The age effects on pathophysiological MS processes, immunosenescence and its relevance to DMT selection or discontinuation are also reviewed. Lastly, the authors discuss the influence of age-associated comorbidities on DMT initiation and drug-induced events.Expert opinion: There is an age discrepancy between pwMS included in regulatory drug trials and an aging real-world MS population. Most trials demonstrate significantly diminished anti-inflammatory efficacy in patients older than 40 years old. Older age is associated with a greater risk for adverse events including serious infections. Age-associated comorbidities influence the risk-benefit analysis and sometimes cause patients to discontinue DMTs. Instead of chronological age cutoffs, therefore, studies should aim at promoting biologically-based age biomarkers.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, NY, USA
| | - Svetlana P Eckert
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, NY, USA.,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, NY, USA
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Increasing cancer risk over calendar year in people with multiple sclerosis: a case-control study. J Neurol 2020; 268:817-824. [PMID: 33084939 PMCID: PMC7914231 DOI: 10.1007/s00415-020-10170-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022]
Abstract
Background Data on cancer prevalence and incidence in multiple sclerosis (MS) patients are controversial. This study is aimed at estimating cancer risk in MS patients. Methods Nested case–control study using data collected between 01/01/1987 and 28/02/2016 from the United Kingdom Clinical Practice Research Datalink. Cancer diagnoses after first MS code (index date) was counted in 10,204 MS patients and 39,448 controls matched by sex, age, general practitioner, and registration year. Cancer rates were compared using multivariable Cox regression models. Ethics approval was not required. Results Cancer was reported in 433 (4.41%) MS patients and 2014 (5.31%) controls after index date. Cancer risk was associated with gender (HR for female = 0.88, 95% CI = 0.81–0.96, p = 0.004), age at index date (HR = 1.06, 95% CI = 1.06–1.07, p < 0.001), and index year (HR = 1.01, 95% CI = 1.00–1.02, p = 0.016), but not with MS status (HR = 0.95, 95% CI = 0.86–1.05, p = 0.323). A significant interaction between MS status and index year was found (HR = 1.02, 95% CI = 1.00–1.04, p = 0.022). Cancer risk was positively associated with index year among MS patients (HR = 1.03, 95% CI = 1.01–1.05; p = 0.010), but not controls (HR = 1.01, 95% CI = 0.99–1.02; p = 0.144). MS patients compared to controls had no increased risk for any specific cancer type. Conclusions Overall cancer risk was similar in multiple sclerosis patients and matched controls. The frequency of cancer diagnoses has increased over time among MS patients but not in controls. Electronic supplementary material The online version of this article (10.1007/s00415-020-10170-5) contains supplementary material, which is available to authorized users.
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Risk of cancer in multiple sclerosis (MS): A systematic review and meta-analysis. Autoimmun Rev 2020; 19:102650. [PMID: 32801049 DOI: 10.1016/j.autrev.2020.102650] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 02/29/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the pooled risk of cancer in patients with multiple sclerosis. METHODS We searched PubMed, Scopus, EMBASE, Web of Science, Ovid, google scholar and gray literature (references of studies, conference abstracts) which were published up to September 2019. The search strategy included the MeSH and text words as ((cancer) OR tumor) OR neoplasm) OR "malignant neoplasm) OR "benign neoplasm) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating). RESULTS The first literature search revealed 18,996 articles. After deletion of duplicate articles, finally, 264 articles remained. Excluding non-relevant articles, resulted in including 5 articles which met inclusion criteria. The RR estimated between 0.7 and 1.67 in included articles. The pooled RR estimated as 0.83 (95% CI:0.73-0.96) (I2 = 90%, P < 0.001). Two studies provided prevalence of different cancers. The pooled prevalence of breast cancer in two studies was 2% (95%CI:2%-2%) (I2 = 0%). The pooled prevalence of digestive system cancer in two studies was 2% (95%CI:1%-2%) (I2 = 0%). The pooled prevalence of skin cancer in two studies was 1% (95%CI:0%-1%) (I2 = 0). CONCLUSION The result of this systematic review showed that the risk of cancer in patients with MS is less than the general population.
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Effects on Melanoma Cell Lines Suggest No Significant Risk of Melanoma Under Cladribine Treatment. Neurol Ther 2020; 9:599-604. [PMID: 32712904 PMCID: PMC7606413 DOI: 10.1007/s40120-020-00204-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Indexed: 11/18/2022] Open
Abstract
Cladribine is an oral synthetic purine analog that depletes lymphocytes and induces a dose-dependent reduction of T and B cells. It was approved for the therapy of highly active relapsing-remitting multiple sclerosis. Given cladribine’s mechanism of action, an increased risk of malignancies was suspected from the number of cancers that occurred in the 3.5 mg/kg-treated arm (CLARITY study). We showed that cladribine inhibits cell proliferation on three melanoma cell lines tested, irrespectively of their mutational oncogenic status and invasive/metastatic potential. Aggregated safety data demonstrated that the risk of melanoma is not confirmed.
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Melamed E, Lee MW. Multiple Sclerosis and Cancer: The Ying-Yang Effect of Disease Modifying Therapies. Front Immunol 2020; 10:2954. [PMID: 31998289 PMCID: PMC6965059 DOI: 10.3389/fimmu.2019.02954] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022] Open
Abstract
Over the past two decades, the field of multiple sclerosis (MS) has been transformed by the rapidly expanding arsenal of new disease modifying therapies (DMTs). Current DMTs for MS aim to modulate innate and adaptive immune responses toward a less inflammatory phenotype. Since the immune system is also critical for identifying and eliminating malignant cells, immunosuppression from DMTs may predictably increase the risk of cancer development in MS patients. Compared with healthy controls, patients with autoimmune conditions, such as MS, may already have a higher risk of developing certain malignancies and this risk may further be magnified by DMT treatments. For those patients who develop both MS and cancer, these comorbid presentations create a challenge for clinicians on how to therapeutically address management of cancer in the context of MS autoimmunity. As there are currently no accepted guidelines for managing MS patients with prior history of or newly developed malignancy, we undertook this review to evaluate the molecular mechanisms of current DMTs and their potential for instigating and treating cancer in patients living with MS.
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Affiliation(s)
- Esther Melamed
- Department of Neurology, Dell Medical School, Austin, TX, United States
| | - Michael William Lee
- Department of Oncology, Department of Medical Education, Dell Medical School, Austin, TX, United States
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The 5-year Tysabri global observational program in safety (TYGRIS) study confirms the long-term safety profile of natalizumab treatment in multiple sclerosis. Mult Scler Relat Disord 2019; 39:101863. [PMID: 31901758 DOI: 10.1016/j.msard.2019.101863] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/13/2019] [Accepted: 11/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Natalizumab is an effective treatment for multiple sclerosis (MS) and has a well-characterized safety profile, with more than 10 years of postmarketing experience. TYGRIS was a 5-year observational cohort study designed to obtain long-term safety data in natalizumab-treated MS patients. We examined the incidence and pattern of serious adverse events (SAEs) in this large postmarketing sample of natalizumab-treated patients. METHODS Investigators reported SAEs in natalizumab-treated patients. Malignancy incidence rates were compared with rates in the general population using external databases. RESULTS Of 6508 enrolled patients, 4938 (75.9%) completed the study. SAEs occurring in more than 0.5% of patients included urinary tract infection (n = 50; 0.8%), pneumonia (n = 46; 0.7%), progressive multifocal leukoencephalopathy (PML; n = 44; 0.7%), and immune reconstitution inflammatory syndrome (n = 44; 0.7%). Fifty-five patients (0.9%) experienced treatment-emergent serious opportunistic infections, 44 of which were PML. Two patients with PML died. The overall malignancy incidence rate was 449.0 per 100,000 patient-years (95% confidence interval [CI], 375.1-533.1). With few exceptions, incidence rates for individual malignancies had 95% CIs encompassing incidence rates in the general population. Hepatotoxic events occurred in 6 patients; 4 patients had evidence of alternative cause or confounders. Of 96 fatal events, investigators considered 81 unrelated or unlikely to be related to treatment and 5 related or possibly related; causality was not provided for 10. CONCLUSION Data from this large, long-term study indicate that the nature, character, and frequency of SAEs in real-world settings are consistent with natalizumab's known safety profile. (Funded by Biogen; ClinicalTrials.gov identifiers: NCT00477113 and NCT00483847.).
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Bruno D, Marc D, Ouarda P, Dominique S, Marc S, Laurène C, Khalil J, Jonathan E, Francis G. Economic burden of multiple sclerosis in France estimated from a regional medical registry and national sick fund claims. Mult Scler Relat Disord 2019; 36:101396. [DOI: 10.1016/j.msard.2019.101396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/22/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
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Hongell K, Kurki S, Sumelahti ML, Soilu-Hänninen M. Risk of cancer among Finnish multiple sclerosis patients. Mult Scler Relat Disord 2019; 35:221-227. [DOI: 10.1016/j.msard.2019.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 12/12/2022]
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D'Amico E, Chisari CG, Arena S, Zanghì A, Toscano S, Lo Fermo S, Maimone D, Castaing M, Sciacca S, Zappia M, Patti F. Cancer Risk and Multiple Sclerosis: Evidence From a Large Italian Cohort. Front Neurol 2019; 10:337. [PMID: 31024431 PMCID: PMC6469363 DOI: 10.3389/fneur.2019.00337] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/19/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: The complexity of understanding cancer risk in MS is increased by inconsistencies in study design, and the lack of age-, sex-, and ethnicity-specific risk estimates. Aims of our study were to estimate the incidence of cancers in the MS population of Catania (Italy) and to evaluate the impact of disease-modifying treatments (DMTs) in cancer risk. Materials and Methods: We screened 2,730 PwMS according to the MS criteria of Mc Donald 2010 referring to MS center of Catania in the period between 2003 and 2013. We matched database of MS patients with the Integrated Cancer of Catania-Messina-Siracusae-Enna. We calculated age and sex specific standardized incidence ratios (SIR) and the relative risk (RR) of developing cancer in MS patients treated with at least two different DMTs compared to who received one or no treatment. Results: Out of 2,730, 1,180 MS patients (67.1% females; mean age 41.2 ± 12.9) were enrolled. We found 36 cancers. Global SIR was 1.18 (CI95% 0.78–1.58), with a significantly higher risk in men with a range age of 20 to 50 years [2.84; (CI95% 1.59–4.09)] and in women over 50 years [1.82 (CI95% 1.08–2.55)]. RR of developing cancer was 1.99 (CI95% 1.14–3.45) in MS patients switching one DMT and 3.38 (CI95% 1.83–6.22) in who switched at least twice. Discussion: Our results demonstrated that cancer risk was not increased in our MS population; but age and sex different distribution may partly drive cancer risk. Higher cancer risk in MS patients switching more than two DMTs should take into account in treatment decision making.
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Affiliation(s)
- Emanuele D'Amico
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Clara G Chisari
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Sebastiano Arena
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Aurora Zanghì
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Simona Toscano
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Salvatore Lo Fermo
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | | | - Marine Castaing
- Department of Hygiene, University of Catania, Catania, Italy
| | | | - Mario Zappia
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Francesco Patti
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
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Nørgaard M, Veres K, Didden E, Wormser D, Magyari M. Multiple sclerosis and cancer incidence: A Danish nationwide cohort study. Mult Scler Relat Disord 2019; 28:81-85. [DOI: 10.1016/j.msard.2018.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/20/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Lebrun C, Rocher F. Cancer Risk in Patients with Multiple Sclerosis: Potential Impact of Disease-Modifying Drugs. CNS Drugs 2018; 32:939-949. [PMID: 30143945 DOI: 10.1007/s40263-018-0564-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In the 1990s, the first disease-modifying therapies (DMTs) for multiple sclerosis (MS) were injectable immunomodulatory (IM) drugs, including four different interferon-β preparations and glatiramer acetate. Since 2000, more than 15 immunosuppressant (IS) drugs have been used, with a more or less specific action on inflammation. These include monoclonal antibodies targeting CTL4, the integrin receptor, the interleukin (IL)-2 receptor, CD19, CD20, CD52, and the sphingosine 1 phosphate family. The association between MS and cancer has long been investigated but has led to conflicting results. No studies have reported an increased risk of cancer after long-term exposure to IM. Several reports suggest an increase in cancer risk among MS patients treated with IS such as mitoxantrone, azathioprine and cyclophosphamide. Because of their action on the immune system, and due to a lack of available long-term data, a special warning of the potential risk of cancer accompanies the use of recent IS such as cladribine, fingolimod, natalizumab or alemtuzumab. In most studies, factors such as diet, smoking, solar radiation, and hormone therapy, all of which influence cancer risk, have not been considered. For fingolimod, natalizumab, alemtuzumab, dimethyl fumarate, teriflunomide, daclizumab and ocrelizumab, risk management plans outlined by regulatory agencies are mandatory. They allow prospective detection of some red flags, in particular those for the increased risk of cancer. We review the current evidence behind the increased risk of malignancy in MS patients receiving DMTs, and provide an overview of the DMTs that are currently in use and those in clinical trials. The known risks and benefits of these therapies will be considered.
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Affiliation(s)
- Christine Lebrun
- Centre de Ressources et Compétences Sclérose En Plaques, Neurologie, Université Nice Côte d'Azur, CHU Pasteur 2, 30 voie Romaine, 06002, Nice, France.
| | - Fanny Rocher
- Centre Régional de Pharmacovigilance, CHU Cimiez, Nice, France
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Decreased prevalence of cancer in patients with multiple sclerosis: A case-control study. PLoS One 2017; 12:e0188120. [PMID: 29176769 PMCID: PMC5703510 DOI: 10.1371/journal.pone.0188120] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 10/31/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Studies of cancer prevalence have produced conflicting results concerning the relative risk of overall and specific sub-types of cancer in patients with multiple sclerosis (MS). Contemporary controls and information on tobacco use and alcohol consumption are generally missing from previous studies. OBJECTIVES To evaluate lifetime cancer prevalence in a large cohort of MS patients relative to appropriate controls. METHODS We conducted a case-control study, using a postal survey of a cohort of MS patients. Of the 1574 questionnaires sent, 1107 could be used for statistical analysis. Data from 1568 controls were prospectively collected using the same self-administered survey among consecutive out-patients in a single neurology department. Propensity scores matched on age, gender, and history of smoking and alcohol consumption were calculated. RESULTS Among the MS patients, 7.32% had ever presented with a cancer, whereas 12,63% of the controls had, leading to a bootstrap matched odds ratio (OR) of 0.63; 95% CI 0.57-0.70. Although only exploratory, the use of DMT (immunomodulators or immunosupressants) did not appear to increase this risk (p = 0.42). The disease course also did not affect cancer prevalence. CONCLUSION MS was associated with a reduced overall cancer risk.
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Kantorová E, Bittšanský M, Sivák Š, Baranovičová E, Hnilicová P, Nosáľ V, Čierny D, Zeleňák K, Brück W, Kurča E. Anaplastic astrocytoma mimicking progressive multifocal leucoencephalopathy: a case report and review of the overlapping syndromes. BMC Cancer 2017. [PMID: 28629398 PMCID: PMC5477142 DOI: 10.1186/s12885-017-3415-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Co-occurrence of multiple sclerosis (MS) and glial tumours (GT) is uncommon although occasionally reported in medical literature. Interpreting the overlapping radiologic and clinical characteristics of glial tumours, MS lesions, and progressive multifocal leukoencephalopathy (PML) can be a significant diagnostic challenge. Case presentation We report a case of anaplastic astrocytoma mimicking PML in a 27-year-old patient with a 15-year history of MS. She was treated with interferon, natalizumab and finally fingolimod due to active MS. Follow-up MRI, blood and cerebrospinal fluid examinations, and biopsy were conducted, but only the latter was able to reveal the cause of progressive worsening of patient’s disease. Conclusions Anaplastic astrocytoma misdiagnosed as PML has not yet been described. We suppose that the astrocytoma could have evolved from a low grade glioma to anaplastic astrocytoma over time, as the tumour developed adjacent to typical MS plaques. The role of the immunomodulatory treatment as well as other immunological factors in the malignant transformation can only be hypothesised. We discuss clinical, laboratory and diagnostic aspects of a malignant GT, MS lesions and PML. The diagnosis of malignant GT must be kept in mind when an atypical lesion develops in a patient with MS.
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Affiliation(s)
- Ema Kantorová
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic.
| | - Michal Bittšanský
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
| | - Štefan Sivák
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
| | - Eva Baranovičová
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
| | - Petra Hnilicová
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
| | - Vladimír Nosáľ
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
| | - Daniel Čierny
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
| | - Kamil Zeleňák
- Clinic of Radiodiagnostics, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
| | - Wolfgang Brück
- Institut für Neuropathologie Universitätsmedizin Göttingen, Robert-Koch-Str, 40 37075, Göttingen, Germany
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovak Republic
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Gaindh D, Kavak KS, Teter B, Vaughn CB, Cookfair D, Hahn T, Weinstock-Guttman B. Decreased risk of cancer in multiple sclerosis patients and analysis of the effect of disease modifying therapies on cancer risk. J Neurol Sci 2016; 370:13-17. [DOI: 10.1016/j.jns.2016.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022]
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Thormann A, Koch-Henriksen N, Laursen B, Sørensen PS, Magyari M. Inverse comorbidity in multiple sclerosis: Findings in a complete nationwide cohort. Mult Scler Relat Disord 2016; 10:181-186. [PMID: 27919487 DOI: 10.1016/j.msard.2016.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/05/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Inverse comorbidity is disease occurring at lower rates than expected among persons with a given index disease. The objective was to identify inverse comorbidity in MS. METHODS We performed a combined case-control and cohort study in a total nationwide cohort of cases with clinical onset of MS 1980-2005. We randomly matched each MS-case with five population controls. Comorbidity data were obtained from multiple, independent nationwide registries. Cases and controls were followed from January 1977 to the index date, and from the index date through December 2012. We controlled for false discovery rate and investigated each of eight pre-specified comorbidity categories: psychiatric, cerebrovascular, cardiovascular, lung, and autoimmune comorbidities, diabetes, cancer, and Parkinson's disease. RESULTS A total of 8947 MS-cases and 44,735 controls were eligible for inclusion. We found no inverse associations with MS before the index date. After the index date, we found a decreased occurrence of chronic lung disease (asthma and chronic obstructive pulmonary disease) (HR 0.80 (95% CI 0.75-0.86, p<0.00025)) and overall cancer (HR 0.88 (95% CI 0.81-0.95, p=0.0005)) among MS-cases. CONCLUSION This study showed a decreased risk of cancers and pulmonary diseases after onset of MS. Identification of inverse comorbidity and of its underlying mechanisms may provide important new entry points into the understanding of MS.
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Affiliation(s)
- Anja Thormann
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | - Nils Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark
| | - Bjarne Laursen
- The Danish National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen K, Denmark
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Hajiebrahimi M, Montgomery S, Burkill S, Bahmanyar S. Risk of Premenopausal and Postmenopausal Breast Cancer among Multiple Sclerosis Patients. PLoS One 2016; 11:e0165027. [PMID: 27776164 PMCID: PMC5077134 DOI: 10.1371/journal.pone.0165027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/05/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate risk of premenopausal and postmenopausal breast cancer among Multiple Sclerosis (MS) patients, considering tumor stage. Methods The Swedish Patient Register identified 19,330 women with MS between 1968 and 2012, matched individually with a cohort of 193,458 without MS. Matching variables were year of birth, sex, region of residence and vital status at the time of diagnosis. The cancer register identified 471 and 5,753 breast cancer cases among the MS and non-MS cohorts, respectively. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (CI) for premenopausal and postmenopausal breast cancer. Results Overall risk of postmenopausal breast cancer was 13% higher among MS patients compared with women without MS (HR = 1.13, 95% CI 1.02–1.26). Stratified analyses showed that the risk was statistically significantly increased in women diagnosed between 1968 and 1980 and those who were diagnosed at age 65 or older age. We observed a non-statistically significant risk only for stage 0–1 postmenopausal breast cancer (HR = 1.17, 95% CI 0.93–1.48). MS was not associated with premenopausal breast cancer. Conclusion The modest increased risk of postmenopausal breast cancer in women with MS may be due to surveillance bias, where contact with health services for one disease increases the risk of a second diagnosis being recorded.
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Affiliation(s)
- Mohammadhossein Hajiebrahimi
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health, Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran
- * E-mail:
| | - Scott Montgomery
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Sarah Burkill
- Center for Pharmacoepidemiology & Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shahram Bahmanyar
- Center for Pharmacoepidemiology & Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health, Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran
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Buttmann M, Seuffert L, Mäder U, Toyka KV. Malignancies after mitoxantrone for multiple sclerosis: A retrospective cohort study. Neurology 2016; 86:2203-7. [PMID: 27170571 PMCID: PMC4898319 DOI: 10.1212/wnl.0000000000002745] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/02/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the therapy-related risk of malignancies in mitoxantrone-treated patients with multiple sclerosis. METHODS This retrospective observational cohort study included all mitoxantrone-treated patients with multiple sclerosis seen at our department between 1994 and 2007. We collected follow-up information on medically confirmed malignancies, life status, and cause of death, as of 2010. Malignancy rates were compared to the German national cancer registry matched for sex, age, and year of occurrence. RESULTS Follow-up was completed in 676 of 677 identified patients. Median follow-up time was 8.7 years (interquartile range 6.8-11.2), corresponding to 6,220 person-years. Median cumulative mitoxantrone dose was 79.0 mg/m(2) (interquartile range 50.8-102.4). Thirty-seven patients (5.5%) were diagnosed with a malignancy after mitoxantrone initiation, revealing a standardized incidence ratio of 1.50 (95% confidence interval [CI] 1.05-2.08). Entities included breast cancer (n = 9), colorectal cancer (n = 7), acute myeloid leukemia (n = 4, 0.6%), and others (each entity n = 1 or 2). The standardized incidence ratio of colorectal cancer was 2.98 (95% CI 1.20-6.14) and of acute myeloid leukemia 10.44 (95% CI 3.39-24.36). It was not increased for other entities including breast cancer. Multivariate Cox regression identified higher age at treatment initiation but neither cumulative mitoxantrone dose (>75 vs ≤75 mg/m(2)) nor treatment with other immunosuppressive drugs or sex as a risk factor. Fifty-five patients had died, among them 12 of a malignancy and 43 reportedly of other causes. CONCLUSIONS While the overall incidence of malignancies was only mildly increased, the risk of leukemia and colorectal cancer was heightened. If confirmed, posttherapy colonoscopy could become advisable.
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Affiliation(s)
- Mathias Buttmann
- From the Department of Neurology (M.B., L.S., K.V.T.) and the Comprehensive Cancer Center Mainfranken (U.M.), University of Würzburg, Germany.
| | - Linda Seuffert
- From the Department of Neurology (M.B., L.S., K.V.T.) and the Comprehensive Cancer Center Mainfranken (U.M.), University of Würzburg, Germany
| | - Uwe Mäder
- From the Department of Neurology (M.B., L.S., K.V.T.) and the Comprehensive Cancer Center Mainfranken (U.M.), University of Würzburg, Germany
| | - Klaus V Toyka
- From the Department of Neurology (M.B., L.S., K.V.T.) and the Comprehensive Cancer Center Mainfranken (U.M.), University of Würzburg, Germany
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Kyritsis AP, Boussios S, Pavlidis N. Cancer specific risk in multiple sclerosis patients. Crit Rev Oncol Hematol 2016; 98:29-34. [DOI: 10.1016/j.critrevonc.2015.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/25/2015] [Accepted: 10/01/2015] [Indexed: 12/28/2022] Open
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Bártulos Iglesias M, Marzo Sola M, Estrella Ruiz L, Bravo Anguiano Y. Estudio epidemiológico de la esclerosis múltiple en La Rioja. Neurologia 2015; 30:552-60. [DOI: 10.1016/j.nrl.2014.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 03/10/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022] Open
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Gajofatto A, Benedetti MD. Treatment strategies for multiple sclerosis: When to start, when to change, when to stop? World J Clin Cases 2015; 3:545-555. [PMID: 26244148 PMCID: PMC4517331 DOI: 10.12998/wjcc.v3.i7.545] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/02/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory condition of the central nervous system determined by a presumed autoimmune process mainly directed against myelin components but also involving axons and neurons. Acute demyelination shows as clinical relapses that may fully or partially resolve, while chronic demyelination and neuroaxonal injury lead to persistent and irreversible neurological symptoms, often progressing over time. Currently approved disease-modifying therapies are immunomodulatory or immunosuppressive drugs that significantly although variably reduce the frequency of attacks of the relapsing forms of the disease. However, they have limited efficacy in preventing the transition to the progressive phase of MS and are of no benefit after it has started. It is therefore likely that the potential advantage of a given treatment is condensed in a relatively limited window of opportunity for each patient, depending on individual characteristics and disease stage, most frequently but not necessarily in the early phase of the disease. In addition, a sizable proportion of patients with MS may have a very mild clinical course not requiring a disease-modifying therapy. Finally, individual response to existing therapies for MS varies significantly across subjects and the risk of serious adverse events remains an issue, particularly for the newest agents. The present review is aimed at critically describing current treatment strategies for MS with a particular focus on the decision of starting, switching and stopping commercially available immunomodulatory and immunosuppressive therapies.
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Roshanisefat H, Bahmanyar S, Hillert J, Olsson T, Montgomery S. All-cause mortality following a cancer diagnosis amongst multiple sclerosis patients: a Swedish population-based cohort study. Eur J Neurol 2015; 22:1074-80. [DOI: 10.1111/ene.12710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/06/2015] [Indexed: 01/09/2023]
Affiliation(s)
- H. Roshanisefat
- Department of Neurology; Karolinska University Hospital Huddinge; Stockholm Sweden
- Neuroimmunology Unit; Department of Clinical Neuroscience and Centre for Molecular Medicine; Karolinska Institute and Karolinska University Hospital; Solna Sweden
| | - S. Bahmanyar
- Clinical Epidemiology Unit and Centre for Pharmacoepidemiology; Department of Medicine; Karolinska University Hospital and Karolinska Institute; Stockholm Sweden
- Faculty of Medicine; Golestan University of Medical Sciences; Gorgan Iran
| | - J. Hillert
- Department of Neurology; Karolinska University Hospital Huddinge; Stockholm Sweden
- Neuroimmunology Unit; Department of Clinical Neuroscience and Centre for Molecular Medicine; Karolinska Institute and Karolinska University Hospital; Solna Sweden
| | - T. Olsson
- Neuroimmunology Unit; Department of Clinical Neuroscience and Centre for Molecular Medicine; Karolinska Institute and Karolinska University Hospital; Solna Sweden
| | - S. Montgomery
- Clinical Epidemiology Unit and Centre for Pharmacoepidemiology; Department of Medicine; Karolinska University Hospital and Karolinska Institute; Stockholm Sweden
- Clinical Epidemiology and Biostatistics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Research Department of Epidemiology and Public Health; University College London; London UK
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Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, Cutter G, Reider N. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21:263-81. [PMID: 25623244 PMCID: PMC4361468 DOI: 10.1177/1352458514564491] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Comorbidity is an area of increasing interest in multiple sclerosis (MS). Objective: The objective of this review is to estimate the incidence and prevalence of comorbidity in people with MS and assess the quality of included studies. Methods: We searched the PubMed, SCOPUS, EMBASE and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles. Two reviewers independently screened abstracts. One reviewer abstracted data using a standardized form and the abstraction was verified by a second reviewer. We assessed study quality using a standardized approach. We quantitatively assessed population-based studies using the I2 statistic, and conducted random-effects meta-analyses. Results: We included 249 articles. Study designs were variable with respect to source populations, case definitions, methods of ascertainment and approaches to reporting findings. Prevalence was reported more frequently than incidence; estimates for prevalence and incidence varied substantially for all conditions. Heterogeneity was high. Conclusion: This review highlights substantial gaps in the epidemiological knowledge of comorbidity in MS worldwide. Little is known about comorbidity in Central or South America, Asia or Africa. Findings in North America and Europe are inconsistent. Future studies should report age-, sex- and ethnicity-specific estimates of incidence and prevalence, and standardize findings to a common population.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Health Sciences Center, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Canada
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Marrie RA, Reider N, Cohen J, Stuve O, Trojano M, Sorensen PS, Reingold SC, Cutter G. A systematic review of the incidence and prevalence of cancer in multiple sclerosis. Mult Scler 2014; 21:294-304. [PMID: 25533302 PMCID: PMC4429168 DOI: 10.1177/1352458514564489] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies of cancer incidence and prevalence in multiple sclerosis (MS) have produced conflicting results. OBJECTIVE To estimate the incidence and prevalence of cancer in persons with MS and review the quality of included studies. METHODS We searched the PUBMED, SCOPUS, Web of Knowledge, and EMBASE databases, conference proceedings, and reference lists of all articles retrieved. Abstracts were screened for relevance by two reviewers. Data from included articles were captured using a standardized form, and the abstraction was verified by a second reviewer. We assessed quality of the included studies. We quantitatively assessed studies using the I (2) statistic, and conducted meta-analyses for population-based studies. RESULTS We identified 38 studies. Estimates for incidence and prevalence varied substantially for most cancers. In population-based studies, cervical, breast, and digestive cancers had the highest incidence. The risk of meningiomas and urinary system cancers appeared higher than expected, while the risks of pancreatic, ovarian, prostate and testicular cancer were lower than expected. CONCLUSION The complexity of understanding cancer risk in MS is augmented by inconsistencies in study design, and the relative paucity of age, sex and ethnicity-specific risk estimates from which the strong impact of age on the incidence of cancers can be assessed.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada/Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
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Kingwell E, Evans C, Zhu F, Oger J, Hashimoto S, Tremlett H. Assessment of cancer risk with β-interferon treatment for multiple sclerosis. J Neurol Neurosurg Psychiatry 2014; 85:1096-102. [PMID: 24594506 DOI: 10.1136/jnnp-2013-307238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The risk of cancer after exposure to the β-interferons (IFNβs) for multiple sclerosis (MS) has not been established. We assessed whether IFNβ treatment for MS is associated with cancer risk or the risk of specific cancers in a population-based observational study. METHODS The British Columbia MS database was linked to the provincial Cancer Registry, Vital Statistics death files and Health Registration files. Using a nested case-control design, MS cancer cases were matched with up to 20 randomly selected MS controls at the date of cancer diagnosis by sex, age (± 5 years) and study entry year using incidence density sampling. Associations between treatment exposure and overall or specific (breast, colorectal, lung and prostate) cancers were estimated by conditional logistic regression, adjusted for MS disease duration and age. Tumour size at cancer diagnosis was compared between treated and untreated patients using the stratified Wilcoxon test to explore potential lead time bias. RESULTS The cohort included 5146 relapsing-onset MS patients and 48,705 person-years of follow-up, during which 227 cancers were diagnosed. Exposure to IFNβ was not significantly different for cases and controls (OR 1.28; 95% CI 0.87 to 1.88). There was a non-significant trend towards an increased risk of IFNβ exposure in the breast cancer cases (OR 1.77; 95% CI 0.92 to 3.42), but no evidence of a dose-response effect. Tumour size was similar between IFNβ treated and untreated cases. CONCLUSIONS There was no evidence of an increased cancer risk with exposure to IFNβ over a 12-year observation period. However, the trend towards an association between IFNβ and breast cancer should be investigated further.
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Affiliation(s)
- Elaine Kingwell
- Faculty of Medicine Division of Neurology, Multiple Sclerosis Program University of British Columbia, Vancouver, British Columbia, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Feng Zhu
- Faculty of Medicine Division of Neurology, Multiple Sclerosis Program University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Oger
- Faculty of Medicine Division of Neurology, Multiple Sclerosis Program University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Hashimoto
- Faculty of Medicine Division of Neurology, Multiple Sclerosis Program University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Tremlett
- Faculty of Medicine Division of Neurology, Multiple Sclerosis Program University of British Columbia, Vancouver, British Columbia, Canada
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Krhut J, Hradilek P, Nemec D, Tvrdik J, Zapletalova O, Zvara P. Incidence of the urological tumours in patients suffering from multiple sclerosis. Acta Neurol Scand 2014; 130:193-6. [PMID: 24810630 DOI: 10.1111/ane.12264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the incidence of urological malignancies in MS patients using active screening. MATERIAL AND METHODS A total of 495 MS patients (141 men, 354 women, age of 42±13.4) were included in the study. The duration of disease was 12.3±11 years, and the EDSS score was 4.3 (±2.5). Patients, regardless of specific urological symptoms, were referred for urological evaluation. The outcomes of these evaluations were compared with data from the 2009 National Oncology Register of the Czech Republic. RESULTS The standardized incidence ratio (SIR) for the whole MS study population was 38.8 (95% CI 12.6-90.6). This incidence of urological malignancies in the MS study population was higher (statistically significant) than that of the general population. The SIR for females was 66.0 (95% CI 18.0-169.1) in the MS study population, representing a statistically significant increase over that of the general female population. The increase in incidence of urological malignancies in men with MS did not reach statistical significance over that of the general male population (SIR 14.7, 95% CI 0.4-81.7). CONCLUSIONS The incidence of urological cancer in MS patients as determined by active screening is significantly higher than that found in general population.
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Affiliation(s)
- J. Krhut
- Department of Urology; Ostrava University; Ostrava Czech Republic VT USA
- Department of Urology; University Hospital; Ostrava Czech Republic VT USA
| | - P. Hradilek
- Department of Neurology; University Hospital; Ostrava Czech Republic VT USA
| | - D. Nemec
- Department of Urology; University Hospital; Ostrava Czech Republic VT USA
| | - J. Tvrdik
- Department of Computer Science; Ostrava University; Ostrava Czech Republic VT USA
| | - O. Zapletalova
- Department of Neurology; University Hospital; Ostrava Czech Republic VT USA
| | - P. Zvara
- Department of Urology; Ostrava University; Ostrava Czech Republic VT USA
- Division of Urology; Department of Surgery; University of Vermont; Burlington VT USA
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Anagnostouli M, Anagnostoulis G, Katsavos S, Panagiotou M, Kararizou E, Davaki P. HLA-DRB1*15:01 and Epstein–Barr virus in a multiple sclerosis patient with psoriasis, nasopharyngeal and breast cancers. Lessons for possible hidden links for autoimmunity and cancer. J Neurol Sci 2014; 339:26-31. [DOI: 10.1016/j.jns.2014.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/31/2013] [Accepted: 02/03/2014] [Indexed: 02/06/2023]
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Leboyer M, Tamouza R, Charron D, Faucard R, Perron H. Human endogenous retrovirus type W (HERV-W) in schizophrenia: a new avenue of research at the gene-environment interface. World J Biol Psychiatry 2013; 14:80-90. [PMID: 21936762 DOI: 10.3109/15622975.2010.601760] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Provide a synthetic review of recent studies evidencing an association between human endogenous retrovirus-W (HERV-W) and schizophrenia. METHODS Bibliography analysis and contextual synthesis. RESULTS Epidemiological studies suggest that the aetiology of schizophrenia is complex and involves a complex interplay of genetic and environmental factors such as infections. Eight percentof the human genome consists of human endogenous retroviruses (HERV), and this part of the genome was previously thought to be without importance, but new research has refuted this. HERVs share similarities with viruses and it is assumed that HERVs are present in the genome as a result of retroviruses infecting germ line cells many million years ago. A specific type of HERVs, called HERV-W, has through several recent studies been associated with schizophrenia. Elevated transcription of HERV-W elements has been documented, and antigens of HERV-W envelope and capsid proteins have been found in blood samples from patients. Viruses that have been implicated in pathology of schizophrenia, such as herpes and influenza, have been shown to activate HERV-W elements, and such activation has been associated with elevated biomarkers of systemic inflammation. New research indicates that HERV-W may be an important genetic factor interplaying with the environmental risk factor of infections and that, through this, HERV-W may be important for disease pathogenesis. CONCLUSIONS A lifelong scenario of a detrimental interaction between infectious agents and HERV-W genes may decipher the actual development and course of schizophrenia. Further research is needed to find out if specific treatment strategies could reduce the expression of HERV-W and if this will be associated with remission.
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Affiliation(s)
- Marion Leboyer
- AP-HP, Henri Mondor-Albert Chenevier Hospitals, Department of Psychiatry, Creteil, France
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Galimberti D, Scarpini E. Progress in multiple sclerosis research in the last year. J Neurol 2012; 259:1497-501. [DOI: 10.1007/s00415-012-6578-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/01/2012] [Accepted: 06/02/2012] [Indexed: 11/28/2022]
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Kingwell E, Bajdik C, Phillips N, Zhu F, Oger J, Hashimoto S, Tremlett H. Cancer risk in multiple sclerosis: findings from British Columbia, Canada. ACTA ACUST UNITED AC 2012; 135:2973-9. [PMID: 22730559 DOI: 10.1093/brain/aws148] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Findings regarding cancer risk in people with multiple sclerosis have been inconsistent and few studies have explored the possibility of diagnostic neglect. The influence of a relapsing-onset versus primary progressive course on cancer risk is unknown. We examined cancer risk and tumour size at diagnosis in a cohort of patients with multiple sclerosis compared to the general population and we explored the influence of disease course. Clinical data of patients with multiple sclerosis residing in British Columbia, Canada who visited a British Columbia multiple sclerosis clinic from 1980 to 2004 were linked to provincial cancer registry, vital statistics and health registration data. Patients were followed for incident cancers between onset of multiple sclerosis, and the earlier of emigration, death or study end (31 December 2007). Cancer incidence was compared with that in the age-, sex- and calendar year-matched population of British Columbia. Tumour size at diagnosis of breast, prostate, colorectal and lung cancers were compared with population controls, matched for cancer site, sex, age and calendar year at cancer diagnosis, using the stratified Wilcoxon test. There were 6820 patients included, with 110 666 person-years of follow-up. The standardized incidence ratio for all cancers was 0.86 (95% confidence interval: 0.78-0.94). Colorectal cancer risk was also significantly reduced (standardized incidence ratio: 0.56; 95% confidence interval: 0.37-0.81). Risk reductions were similar by sex and for relapsing-onset and primary progressive multiple sclerosis. Tumour size was larger than expected in the cohort (P = 0.04). Overall cancer risk was lower in patients with multiple sclerosis than in the age-, sex- and calendar year matched general population. The larger tumour sizes at cancer diagnosis suggested diagnostic neglect; this could have major implications for the health, well-being and longevity of people with multiple sclerosis.
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Affiliation(s)
- Elaine Kingwell
- Division of Neurology, Faculty of Medicine, Multiple Sclerosis Program, University of British Columbia, Vancouver, British Columbia, Canada.
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Bloomgren G, Sperling B, Cushing K, Wenten M. Assessment of malignancy risk in patients with multiple sclerosis treated with intramuscular interferon beta-1a: retrospective evaluation using a health insurance claims database and postmarketing surveillance data. Ther Clin Risk Manag 2012; 8:313-21. [PMID: 22767995 PMCID: PMC3387830 DOI: 10.2147/tcrm.s31347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Intramuscular interferon beta-1a (IFNβ-1a), a multiple sclerosis (MS) therapy that has been commercially available for over a decade, provides a unique opportunity to retrospectively assess postmarketing data for evidence of malignancy risk, compared with relatively limited data available for more recently approved therapies. Postmarketing and claims data were analyzed to determine the risk of malignancy in MS patients treated with intramuscular IFNβ-1a. Materials and methods The cumulative reporting rates of suspected adverse drug reactions coded to malignancy in the intramuscular IFNβ-1a global safety database were compared with malignancy incidence rates in the World Health Organization GLOBOCAN database. In addition, using data from a large US claims database, the cumulative prevalence of malignancy in MS patients treated with intramuscular IFNβ-1a was compared with non-MS population controls, MS patients without intramuscular IFNβ-1a use, and untreated MS patients. Mean follow-up was approximately 3 years for all groups, ie, 3.1 years for the intramuscular IFNβ-1a group (range 0.02–6.0 years), 2.6 years for non-MS population controls (range 0–6.0 years), 2.6 years for the intramuscular IFNβ-1a nonuse group (range 0.01–6.0 years), and 2.4 years for the untreated MS group (range 0.01–6.0 years). Results An estimated 402,250 patients received intramuscular IFNβ-1a during the postmarketing period. Cumulative reporting rates of malignancy in this population were consistent with GLOBOCAN incidence rates observed within the general population. The claims database included 12,894 MS patients who received intramuscular IFNβ-1a. No significant difference in malignancy prevalence was observed in intramuscular IFNβ-1a users compared with other groups. Conclusion Results from this evaluation provide no evidence of an increased risk of malignancy with intramuscular IFNβ-1a use.
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