Association between multiple sclerosis, cancer risk, and immunosuppressant treatment: a cohort study

Abstract

BackgroundThe association between multiple sclerosis (MS) and cancer has long been investigated with conflicting results. Several reports suggest an increased cancer risk among MS patients treated with immunosuppressant (IS) drugs.MethodsWe performed a cohort study including MS patients recruited at the Neurological Department of the University of Palermo. Mean follow-up period was ten years for the whole cohort. We calculated cancer incidence among patients treated with IS. Incidence rates were compared in the cohort by calculating the relative risk according to length and dose of exposure to IS. Cancer incidence among MS patients was compared to cancer incidence in the general population of Sicily in similar age groups.ResultsOn an overall cohort of 531 MS patients (346 women and 185 men) exposed to IS, we estimated a crude incidence rate for cancer of 2.26% (2.02% in women, 2.7% in men). Cancer risk was higher compared to rates observed among an equal number of patients not exposed to IS, and to the risk in the general population in Sicily at similar age groups (adjusted HR: 11.05; CI 1.67–73.3; p = 0.013).ConclusionThe present study showed a higher cancer risk in MS patients associated only to previous IS exposure. Studies on long-term outcomes are essential to evaluate the possibility that treatment options that need to be considered for a long time-period may modify risk for life threatening diseases.

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

“…As described, comorbidities in PwMS can impact on DMT adherence and, therefore, and may influence the choice of DMT [3,112],however, this report suggests that DMT use may also increase the risk of developing comorbidity across several conditions in PwMS. For example, interferon beta and glatiramer acetate uses have been associated with an increased prevalence of cardiovascular risk factors, including elevated diastolic blood pressure and plasma glucose, in addition to altered lipid profiles [29],other studies have suggested that DMT use may increase cancer risk in PwMS [94][95][96]. Therefore, improved understanding of the effects of comorbidity on safety, the effectiveness of DMT, and potential interactions between DMT use and comorbidity in PwMS is needed.…”

Multiple Sclerosis and Cancer: The Ying-Yang Effect of Disease Modifying Therapies

“…Several studies have found that while cancer risk in MS patients may not differ from the general population, the risk appears to be lower in male patients compared to female patients, and increases with age (7,14,15). Overall, there is general agreement that immunosuppressant therapies, such as azathioprine, methotrexate, cyclophosphamide, and mitoxantrone have led to increased cancer risks in MS patients and this risk is related to patient's family history of cancer, duration of treatment and cumulative dose (16,17). More recent large cohort studies, have incorporated oral and IV therapies along with other cancer risk factors, such as alcohol and smoking, demonstrating no increase in cancer risk in MS population (7,18,19).…”

Immune Reconstitution Therapy or Continuous Immunosuppression for the Management of Active Relapsing–Remitting Multiple Sclerosis Patients? A Narrative Review

“…Continuous immunosuppression has important functional consequences for the therapeutic use of these drugs, as this treatment has been associated with an increased risk of infections [12,13] and, in some cases, increased risk of malignancy [14,15]. The implications of these observations for individual DMDs, including those that act like IRTs, is described in the following sections.…”