PD47-10 COULD BCG TREATMENT IN PATIENTS (pts) WITH BLADDER CANCER REDUCE THE INCIDENCE OF ALZHEIMER’S DISEASE (AD)?

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-10 COULD BCG TREATMENT IN PATIENTS (pts) WITH BLADDER CANCER REDUCE THE INCIDENCE OF ALZHEIMER’S DISEASE (AD)? Dimitrios Makrakis, Sarah K. Holt, John L. Gore, Petros Grivas, Charles Bernick, and Jonathan L. Wright Dimitrios MakrakisDimitrios Makrakis More articles by this author , Sarah K. HoltSarah K. Holt More articles by this author , John L. GoreJohn L. Gore More articles by this author , Petros GrivasPetros Grivas More articles by this author , Charles BernickCharles Bernick More articles by this author , and Jonathan L. WrightJonathan L. Wright More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A key feature of AD is sustained neuroinflammation. BCG treatment results in systemic immune modulation; BCG immunization in an AD mouse model resulted in improved cognition and reduced inflammation, and a clinical series of pts with bladder cancer associated BCG treatment to lower incidence of AD. We studied the association between BCG therapy and subsequent risk of AD in pts with high-risk (HR) NMIBC. We hypothesized that BCG therapy would be associated with lower risk of AD development. METHODS: Using SEER-Medicare linked data, we identified pts with HR-NMIBC (CIS, high grade Ta/T1) between 2004-2015. Intravesical BCG treatment was characterized and incident AD was determined from diagnostic codes following diagnosis/exposure. We assessed the risk of developing AD by BCG exposure (ever vs. never) using Cox proportional hazards adjusting for demographics (age, sex, race), T stage (Ta, T1, CIS), and Charlson Comorbidity Index (CCI). Additional analyses included BCG dose effect (≤6; 7-12; >12 total injections). RESULTS: We identified 26,584 pts with HR-NMIBC; 13,477 received BCG. Over a median follow-up of 39 months (IQR, 18-71), 2,192 pts (8.2%) were diagnosed with AD. Incident AD was associated with older age, female sex, Black race, and higher CCI (all p <0.0001). After adjusting for these factors, BCG exposure was significantly associated with lower risk of being diagnosed with AD (HR: 0.73, 95% CI: 0.67-0.79). Compared to those not receiving BCG, the risk of AD diagnosis was lower with increasing BCG doses (table). CONCLUSIONS: We found that among more than 26,000 individuals with HR-NMIBC, BCG exposure was associated with risk reduction for subsequent diagnosis of AD. Greater BCG exposure was associated with greater risk reduction. These findings are in line with AD research models and may be due to immune modulation by BCG. Further research is needed to confirm our findings, raising the hypothesis of testing BCG as potential tool to mitigate risk, esp.in individuals at high risk of developing AD. Limitations include retrospective nature, lack of randomization and possible confounding. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e836-e836 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dimitrios Makrakis More articles by this author Sarah K. Holt More articles by this author John L. Gore More articles by this author Petros Grivas More articles by this author Charles Bernick More articles by this author Jonathan L. Wright More articles by this author Expand All Advertisement Loading ...