Multiple sclerosis and cancer incidence: A Danish nationwide cohort study

Nørgaard, Mette; Veres, Katalin; Didden, Eva‐Maria; Wormser, David; Magyari, Melinda

doi:10.1016/j.msard.2018.12.014

Cited by 44 publications

(45 citation statements)

References 27 publications

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“…A decreased risk for some types of cancer in the population with MS with clinical onset between 1980 and 2005 was reported by linking multiple, independent Danish nationwide registries (28). A recent Danish study based on linkage of medical registers confirmed that the incidence of cancer in MS patients was similar to the background population, and persons with MS did not have increased cancer-specific mortality (35). This is generally consistent with prior results that did not suggest any different risk of malignancy in MS compared to the general population (33,36,37).…”

Section: Cancermentioning

confidence: 97%

Comorbidity in Multiple Sclerosis

2020

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Comorbidities in patients with multiple sclerosis (MS) has become an area of increasing interest in the recent years. A comorbidity is defined as any additional disease that coexists in an individual with a given index disease and that is not an obvious complication of the index disease. The aim of this review is to describe the current evidence regarding the range of comorbidities in the population with MS reported in different countries and the current knowledge about the influence of comorbidities on the clinical features and therapeutic challenges in MS. Certain comorbidities are more prevalent in people with MS such as depression, anxiety, cerebro-and cardiovascular diseases, and certain autoimmune disorders such as diabetes, thyroid disease, and inflammatory bowel disease. A previous perception of a trend toward a lower overall risk of cancer in patients with MS appears to be challenged, but there is no evidence on any higher occurrence of malignancies in the population with MS. Comorbidities may modify the clinical presentation of MS, and have implications for treatment choice, adherence, and outcome. Several comorbid conditions are associated with increased disability progression, including diabetes, hypertension, and chronic obstructive pulmonary disease. Comorbidities are common in MS from the time of diagnosis and may account for some of the heterogeneity observed in MS, including diagnostic delay, clinical presentation, degree of disability progression, rate of health care utilization, working ability, employment status, and quality of life. Coexisting diseases and polypharmacy increase the complexity of patient management and poses major challenges, particularly with the increasing number of immunosuppressive disease-modifying therapies.

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Section: Cancermentioning

confidence: 97%

Comorbidity in Multiple Sclerosis

2020

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“…Consistent with results of previously reported trials, 3,14 the incidence rates of malignancies in patients treated with OCR remain within the range of placebo data from clinical trials in MS and epidemiological data for this patient population. 15,14 A…”

Section: A C C E P T E Dmentioning

confidence: 99%

Five years of ocrelizumab in relapsing multiple sclerosis

et al. 2020

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Objective:To assess over 3 years of follow-up, the effects of maintaining or switching to ocrelizumab (OCR) therapy on clinical and MRI outcomes and safety measures in the open-label extension (OLE) phase of the pooled OPERA studies in relapsing multiple sclerosis.Methods:After 2 years of double-blind, controlled treatment, patients continued OCR (600 mg infusions every 24 weeks) or switched from interferon (IFN) β-1a (44 μg 3 times weekly) to OCR when entering the OLE phase (3 years). Adjusted annualized relapse rate, time to onset of 24-week confirmed disability progression/improvement (CDP/CDI), brain MRI activity (gadolinium-enhanced and new/enlarging T2 lesions), and percentage brain volume change were analyzed.Results:Of patients entering the OLE phase, 88.6% completed Year 5. The cumulative proportion with 24-week CDP was lower in patients who initiated OCR earlier, vs patients initially receiving IFN β-1a (16.1% vs 21.3% at Year 5; p=0.014). Patients continuing OCR maintained, and those switching from IFN β-1a to OCR attained near complete and sustained suppression of new brain MRI lesion activity from Year 3 to 5. Over the OLE phase, patients continuing OCR exhibited less whole brain volume loss from double-blind study baseline vs those switching from IFN β-1a (–1.87% vs –2.15% at Year 5; p<0.01). Adverse events were consistent with past reports and no new safety signals emerged with prolonged treatment.Conclusion:Compared with patients switching from IFN β-1a, earlier and continuous OCR treatment up to 5 years provided sustained benefit on clinical and MRI measures of disease progression.Classification of evidence:This study provides Class III evidence that earlier and continuous treatment with ocrelizumab provided sustained benefit on clinical and MRI outcomes of disease activity and progression compared with patients switching from IFN β-1a. The study is rated Class III because of the initial treatment randomization disclosure that occurred after inclusion in OLE.Clinical Trial Identifier NumbersNCT01247324/NCT01412333

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“…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). Varying study outcomes have been attributed to differences in study design, methodology, sex of participants, accountability for environmental cancer risk factors, and participant geographical location.…”

Section: Introductionmentioning

confidence: 99%

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

Melamed

Lee

2020

Front. Immunol.

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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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Multiple sclerosis and cancer incidence: A Danish nationwide cohort study

Cited by 44 publications

References 27 publications

Comorbidity in Multiple Sclerosis

Comorbidity in Multiple Sclerosis

Five years of ocrelizumab in relapsing multiple sclerosis

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

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