Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients

Abstract Neoplasm development in Multiple Sclerosis (MS) patients treated with disease-modifying therapies (DMTs) has been widely discussed. The aim of this work is to determine neoplasm frequency, relationship with the prescription pattern of DMTs, and influence of the patients’ baseline characteri...

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Autores principales:	Rosalía Gil-Bernal, Juan Luis González-Caballero, Raúl Espinosa-Rosso, Carmen Gómez-Gómez
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9e0434f4136d47b6b5db10f717e47481
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spelling	oai:doaj.org-article:9e0434f4136d47b6b5db10f717e474812021-12-02T17:23:26ZPotential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients10.1038/s41598-021-91912-x2045-2322https://doaj.org/article/9e0434f4136d47b6b5db10f717e474812021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-91912-xhttps://doaj.org/toc/2045-2322Abstract Neoplasm development in Multiple Sclerosis (MS) patients treated with disease-modifying therapies (DMTs) has been widely discussed. The aim of this work is to determine neoplasm frequency, relationship with the prescription pattern of DMTs, and influence of the patients’ baseline characteristics. Data from 250 MS outpatients were collected during the period 1981–2019 from the medical records of the Neurology Service of the HUPM (Hospital Universitario Puerta del Mar)—in Southern Spain—and analysed using Cox models. Neoplasm prevalence was 24%, mainly located on the skin, with cancer prevalence as expected for MS (6.8%). Latency period from MS onset to neoplasm diagnosis was 10.4 ± 6.9 years (median 9.30 [0.9–30.5]). During the observation period β-IFN (70.4% of patients), glatiramer acetate (30.4%), natalizumab (16.8%), fingolimod (24.8%), dimethyl fumarate (24.0%), alemtuzumab (6.0%), and teriflunomide (4.8%) were administered as monotherapy. Change of pattern in step therapy was significantly different in cancer patients vs unaffected individuals (p = 0.011) (29.4% did not receive DMTs [p = 0.000]). Extended Cox model: Smoking (HR = 3.938, CI 95% 1.392–11.140, p = 0.010), being female (HR = 2.006, 1.070–3.760, p = 0.030), and age at MS diagnosis (AGE-DG) (HR = 1.036, 1.012–1.061, p = 0.004) were risk factors for neoplasm development. Secondary progressive MS (SPMS) phenotype (HR = 0.179, 0.042–0.764, p = 0.020) and treatment-time with IFN (HR = 0.923, 0.873–0.977, p = 0.006) or DMF (HR = 0.725, 0.507–1.036, p = 0.077) were protective factors. Tobacco and IFN lost their negative/positive influence as survival time increased. Cox PH model: Tobacco/AGE-DG interaction was a risk factor for cancer (HR = 1.099, 1.001–1.208, p = 0.049), followed by FLM treatment-time (HR = 1.219, 0.979–1.517). In conclusion, smoking, female sex, and AGE-DG were risk factors, and SPMS and IFN treatment-time were protective factors for neoplasm development; smoking/AGE-DG interaction was the main cancer risk factor.Rosalía Gil-BernalJuan Luis González-CaballeroRaúl Espinosa-RossoCarmen Gómez-GómezNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Rosalía Gil-Bernal Juan Luis González-Caballero Raúl Espinosa-Rosso Carmen Gómez-Gómez Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients
description	Abstract Neoplasm development in Multiple Sclerosis (MS) patients treated with disease-modifying therapies (DMTs) has been widely discussed. The aim of this work is to determine neoplasm frequency, relationship with the prescription pattern of DMTs, and influence of the patients’ baseline characteristics. Data from 250 MS outpatients were collected during the period 1981–2019 from the medical records of the Neurology Service of the HUPM (Hospital Universitario Puerta del Mar)—in Southern Spain—and analysed using Cox models. Neoplasm prevalence was 24%, mainly located on the skin, with cancer prevalence as expected for MS (6.8%). Latency period from MS onset to neoplasm diagnosis was 10.4 ± 6.9 years (median 9.30 [0.9–30.5]). During the observation period β-IFN (70.4% of patients), glatiramer acetate (30.4%), natalizumab (16.8%), fingolimod (24.8%), dimethyl fumarate (24.0%), alemtuzumab (6.0%), and teriflunomide (4.8%) were administered as monotherapy. Change of pattern in step therapy was significantly different in cancer patients vs unaffected individuals (p = 0.011) (29.4% did not receive DMTs [p = 0.000]). Extended Cox model: Smoking (HR = 3.938, CI 95% 1.392–11.140, p = 0.010), being female (HR = 2.006, 1.070–3.760, p = 0.030), and age at MS diagnosis (AGE-DG) (HR = 1.036, 1.012–1.061, p = 0.004) were risk factors for neoplasm development. Secondary progressive MS (SPMS) phenotype (HR = 0.179, 0.042–0.764, p = 0.020) and treatment-time with IFN (HR = 0.923, 0.873–0.977, p = 0.006) or DMF (HR = 0.725, 0.507–1.036, p = 0.077) were protective factors. Tobacco and IFN lost their negative/positive influence as survival time increased. Cox PH model: Tobacco/AGE-DG interaction was a risk factor for cancer (HR = 1.099, 1.001–1.208, p = 0.049), followed by FLM treatment-time (HR = 1.219, 0.979–1.517). In conclusion, smoking, female sex, and AGE-DG were risk factors, and SPMS and IFN treatment-time were protective factors for neoplasm development; smoking/AGE-DG interaction was the main cancer risk factor.
format	article
author	Rosalía Gil-Bernal Juan Luis González-Caballero Raúl Espinosa-Rosso Carmen Gómez-Gómez
author_facet	Rosalía Gil-Bernal Juan Luis González-Caballero Raúl Espinosa-Rosso Carmen Gómez-Gómez
author_sort	Rosalía Gil-Bernal
title	Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients
title_short	Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients
title_full	Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients
title_fullStr	Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients
title_full_unstemmed	Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients
title_sort	potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/9e0434f4136d47b6b5db10f717e47481
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Potential risk of disease modifying therapies on neoplasm development and coadjutant factors in multiple sclerosis outpatients

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