Association between suicide and multiple sclerosis: An updated meta-analysis

Shen, Qiuyan; Lü, Haitao; Xie, Dan; Wang, Hui; Zhao, Quanzhen; Xu, Yanming

doi:10.1016/j.msard.2019.06.012

Cited by 24 publications

(26 citation statements)

References 40 publications

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“…Nevertheless, in eight cases, the cause of death could not be verified, and one patient death was caused by pneumonia and sepsis, cases in which we cannot rule out rituximab as a contributing factor. Additionally, three suicides occurred resulting in an incidence rate of 1.2/1000 PY, although increased rates of suicide have been associated with an MS diagnosis 22 …”

Section: Discussionmentioning

confidence: 99%

Serious safety events in rituximab‐treated multiple sclerosis and related disorders

Vollmer

Wallach

Corboy

et al. 2020

Ann Clin Transl Neurol

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Introduction Studies investigating rates and risk factors for serious safety events (SSEs) during rituximab treatment of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and related disorders are limited. Methods Rituximab‐treated patients with MS, NMOSD, or related disorders at the Rocky Mountain and New York University MS Care Centers were included. The follow‐up period was defined as the time from the initial dose of rituximab up to 12 months of last dose of rituximab or ocrelizumab (in patients who switched). Clinician‐reported and laboratory data were retrospectively collected from electronic medical records. Results One‐thousand patients were included comprising 907 MS, 77 NMOSD, and 16 related disorders. Patients had a mean follow‐up of 31.1 months and a mean cumulative rituximab dose of 4012 mg. Of the 169 patients who switched to ocrelizumab, the mean ocrelizumab dose was 1141 mg. Crude incidence rate per 1000 person‐years (PY) for lymphopenia was 19.2, neutropenia 5.6, and hypogammaglobulinemia 17.8. Infections resulting in either hospitalization, IV antibiotics, or using antibiotics ≥14 days occurred at a rate of 38.6/1000 PY. Risk factors for infection were duration of therapy, male gender, increased disability, prior exposure to immunosuppression/chemotherapy, lymphopenia, and hypogammaglobulinemia. Particularly, wheelchair‐bound patients had 8.56‐fold increased odds of infections. Crude incidence rates of malignant cancer were 3.5, new autoimmune disease 2.3, thromboembolic event 3.1, and mortality of 5.4 per 1000 PY. Interpretation Rates of SSEs in patients with MS, NMOSD, and related disorders were low. Through properly assessing risk:benefit of B‐cell depleting therapy in neuroinflammatory disorders and continual monitoring, clinicians may decrease the risk of serious infections.

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Section: Discussionmentioning

confidence: 99%

Serious safety events in rituximab‐treated multiple sclerosis and related disorders

Vollmer

Wallach

Corboy

et al. 2020

Ann Clin Transl Neurol

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“…160,161,163-166,168-170,175 Of note, medical cannabis has limited evidence of neuroprotective action 171 and no evidence of disease-modifying efficacy. 176…”

Section: Clinical Evidence Summary For Cannabis In Select Disease Statesmentioning

confidence: 99%

“…The majority of data suggest that medical cannabis has beneficial effects in the treatment of MS-related symptoms. 159,160,[162][163][164][165][166][167][168][169][170]172,[176][177][178] The positive outcomes are specific to pharmaceutical cannabis-based medications such as nabiximols (Sativex) oromucosal spray, which demonstrated benefit in the treatment of MS-related spasticity and neuropathic pain in multiple clinical trials. 160,161,[163][164][165][166][168][169][170]175 Of note, medical cannabis has limited evidence of neuroprotective action 171 and no evidence of disease-modifying efficacy.…”

Section: Multiple Sclerosis and Spasticitymentioning

confidence: 99%

“…160,161,[163][164][165][166][168][169][170]175 Of note, medical cannabis has limited evidence of neuroprotective action 171 and no evidence of disease-modifying efficacy. 176 The Cannabinoids for Treatment of Spasticity and Other Symptoms Related to Multiple Sclerosis (CAMS) study was the largest randomized controlled trial identified, and it studied spasticity in 630 MS patients. The study found no differences in the Ashworth Spasticity Scale between either oral cannabis extract (THC 2.5 mg:CBD 1.25 mg) or THC (2.5 mg) compared with placebo after 15 weeks.…”

Section: Multiple Sclerosis and Spasticitymentioning

confidence: 99%

“…172 Long-term safety data are lacking for medical cannabis use in MS. There is an association of increased suicide risk 101,176 and cognitive impairment 101 in patients with MS, and some evidence suggests that cannabis-based products can also increase suicide risk 101 and cognitive impairment, 101,163 hence raising concern for putting MS patients at compounded risk. The most commonly reported adverse effects reported in trials were fatigue, weakness, nausea, and dizziness, though in some trials, rates were similar in the placebo groups.…”

Section: Multiple Sclerosis and Spasticitymentioning

confidence: 99%

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Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature

et al. 2020

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Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.

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Bedeutung des assistierten Suizids für die Neurologie nach dem Urteil des Bundesverfassungsgerichts 2020

et al. 2022

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Association between suicide and multiple sclerosis: An updated meta-analysis

Cited by 24 publications

References 40 publications

Serious safety events in rituximab‐treated multiple sclerosis and related disorders

Serious safety events in rituximab‐treated multiple sclerosis and related disorders

Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature

Bedeutung des assistierten Suizids für die Neurologie nach dem Urteil des Bundesverfassungsgerichts 2020

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