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.
Highlights
The association between multiple sclerosis (MS) and cancer has long been investigated with conflicting results
Do generally IS used for MS increase the risk for cancer or is there a particular IS which is mainly associated with increased cancer risk? Is there a difference between cancer risk among MS patients treated with IS and those who were not exposed to IS, compared to people not affected by MS? In order to contribute to assess these issues we performed a cohort study including patients affected by MS exposed to IS, and an equal number of MS patients not exposed to IS to determine cancer risk
Cohort design During the study period (1994, to January 31st, 2011) we identified at our Neurologic Department a cohort of 531 MS patients affected by MS (346 women and 185 men) who took at least one of the three IS (AZA, MX, and CP) independently if they had been treated with interferon or glatiramer
Summary
The association between multiple sclerosis (MS) and cancer has long been investigated with conflicting results. First line treatments for MS until recently, were basically represented by immune modulating drugs like beta interferon or glatiramer acetate, while in patients with more aggressive disease courses or who did not respond to first line treatments, immune suppressors (IS) had been used [2]. For these reasons, azathioprine (AZA) was still in use, even after the introduction of disease modifying. Is there a difference between cancer risk among MS patients treated with IS and those who were not exposed to IS, compared to people not affected by MS (general population)? The present study was aimed to compare cancer incidence among people affected by MS to that in the general population in the same geographic area and in the same period
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