Disease Modifying Therapies Modulate Cardiovascular Risk Factors in Patients with Multiple Sclerosis

Abstract

SUMMARYObjectives: This retrospective study aimed to determine (1) the association between the use of three major disease modifying therapies (DMTs) (Interferon-beta [IFN-b], Glatiramer acetate [GA], Natalizumab [NTZ]) and cardiovascular (CV) risk factors in multiple sclerosis (MS) patients, and (2) the association between the use of CV drugs (antihypertensive, hypolipidemic, and antiplatelets) and other drugs acting on the CV system (antispastics/anticonvulsants/anxyolitics, antidepressants/stimulants), and MS disease severity. Methods: The charts of 188 patients with MS, who were taking one of the three DMTs, and 110 patients, who were na€ ıve to these drugs, were retrospectively reviewed. The obtained data included height and weight, fasting lipid profiles, plasma glucose, systolic and diastolic BP, smoking habit, list of medications, and indicators of MS disease severity. Results: The use of DMTs was associated with higher diastolic BP readings, as well as higher plasma glucose and HDL-C plasma levels. In addition, there was an association between CV risk factors and the type of DMTs. When compared to DMT-na€ ıve patients with MS, the use of IFN-b and GA was associated with higher CV risk factors, whereas the use of NTZ was associated with lower CV risk factors. In DMT-na€ ıve patients, the use of CV and related drugs was associated with higher Extended Disability Status Scale (EDSS) and higher MS Severity Scale (MSSS). Conclusion: There is an association between higher CV risk factors and the use of DMTs. Furthermore, CV and related drugs have the potential for modulating MS disease severity.

Vascular comorbidities in the onset and progression of multiple sclerosis

“…A study by Sternberg and colleagues which compared the lipid profile difference between MS patients who were on disease modifying therapies (DMTs-users) and DMTs-naïve demonstrated a significantly higher HDL in DMTs-users compared to DMTs-naïve. The level of TC and LDL were higher in DMTs-users but not significantly different [48].…”

“…In another study of 430 MS patients by Marrie and colleagues, the age-adjusted prevalence of hypertension in the MS patients was similar to that of the general population (MS: 20.8% versus general population: 22.5% [PR: 0.9; 95% CI: 0.78-1.06]). Studies reporting actual blood pressure values recorded similar values in MS patients compared to controls [8,48,53]. Sternberg and colleagues also reported that there was no significant difference in the use of antihypertensive drugs between MS and non-MS patients.…”

“…A retrospective study by Sternberg and colleague also showed no difference in the prevalence of T2D between MS patients and non-MS patients indicated by the lack of difference in the use of anti-diabetic drugs between the two groups [8,48]. Plasma glucose level was however significantly lower in MS patients compared to non-MS patients [8] and also lower in disease modifying therapies naive (DMTs-naive) MS patients compared to MS patients on disease modifying therapies [48], showing that the chronic use of pharmacological agents by MS patients could increase plasma glucose levels and also modulate the risk of T2D in MS patients.…”

“…Plasma glucose level was however significantly lower in MS patients compared to non-MS patients [8] and also lower in disease modifying therapies naive (DMTs-naive) MS patients compared to MS patients on disease modifying therapies [48], showing that the chronic use of pharmacological agents by MS patients could increase plasma glucose levels and also modulate the risk of T2D in MS patients.…”

“…The disparities in the lipid profile could stem from differences in the [49] use of DMTs and other unrelated MS pharmacological agents which has been shown to modulate the lipid profiles [48]. The disparity in dyslipidaemia and lipid profile between the studies examined above could also be due to difference in what constitute a dyslipidaemia (cut off point), difference in population and age of MS patients recruited in the various studies.…”