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

Papadopoulos, Dimitrios; Gklinos, Panagiotis; Psarros, Giorgos; Drellia, Konstantina; Delicha, Eumorphia Maria; Friede, Tim; Mitsikostas, Dimos D.; Nicholas, Richard

doi:10.1007/s00415-021-10932-9

Cited by 2 publications

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“…Although Grytten et al reported an increased incidence of cancer among MS patients compared to controls for the time period from 1996 to 2017, corresponding in time to the introduction of DMT for MS, this effect has been observed predominantly among MS patients older than 60 years of age [ 12 ] and other studies analyzing similar time periods could not confirm these findings but reported instead no increased incidence of malignancy, neither in comparison with the general population nor in relation to DMT [ 13 , 14 ]. A recent meta-analysis with meta-regression by Papadopoulos et al found that treatment with DMT did not modify the risk of neoplasms in MS clinical trials from 1991 to 2020, which may reflect a low carcinogenic potential of DMTs and/or that the neoplasia latencies far exceed the typical MS trial observation periods [ 15 ]. 43.75% of our patients started or kept their MS therapy after tumor diagnosis, which might have been motivated by the concern of ongoing MS disease activity.…”

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confidence: 99%

Concurrent CNS tumors and multiple sclerosis: retrospective single-center cohort study and lessons for the clinical management

et al. 2022

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Introduction The concurrent presence of both central nervous system (CNS) tumors and multiple sclerosis (MS) poses various diagnostic and therapeutic pitfalls and makes the clinical management of such patients challenging. Methods In this retrospective, single-center cohort study, we searched our clinical databases (2006–2019) for patients with concurrent CNS tumors and MS and described their disease courses. Age at diagnosis of the respective disease and probabilities for MS disease activity events (DAEs) with vs. without prior tumor-specific therapy were tested pairwise using t-test for dependent samples and exact binomial test. Results N = 16 patients with concurrent CNS tumors and MS were identified. MS diagnosis preceded the CNS oncological diagnosis by an average of 9 years (p = 0.004). More DAEs occurred in patients without prior chemotherapy (83.3%) than in patients with prior chemotherapy (16.7%; p = 0.008). This effect did not reach significance for patients with prior radiation therapy/radiosurgery (66.7% vs. 33.3%, p = 0.238). The average interval between DAEs and the last documented lymphopenia was 32.25 weeks. Conclusions This study describes the clinical and demographic features of patients with concurrent CNS tumors and MS and suggests several practical approaches to their clinical management. Our findings suggest that adding a disease-modifying MS therapy to the regimen of patients treated with chemotherapy is necessary only if the patient suffers from a highly active, aggressive course of MS. In view of the lack of prospective trials, individual risk assessments should remain the foundation of the decision on MS treatment in concurrent CNS tumor diseases.

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