title: Cancer incidence in multiple sclerosis and effects of immunomodulatory treatments.
abstract: Multiple sclerosis (MS) has been linked to reduced rates of cancer prior to the era of immunomodulating treatments. We assessed the incidence of cancer in a cohort of 1338 MS patients and evaluated the effect of exposure to immunomodulatory treatment. Cancer incidence in the MS population was compared with the expected age- and gender-matched incidence rates in the Israeli population for the period 1960-2003. Time-dependant Cox model analysis was used to estimate hazard ratios for glatiramer acetate, beta-interferons (1a and 1-b) and intravenous immunoglobulins (IVIg). Among 892 female MS patients, 15 (1.7%) developed breast cancer, and 31 (3.5%) developed cancers of any type. Seventeen of 446 (3.8%) male MS patients developed cancer. The standardized incidence ratios (SIRs) computed until the time of first immunomodulatory treatment were 0.60 (95% CI, 0.38-0.92, p = 0.02) for all female cancer, and 1.11 (95% CI, 0.64-1.91) for all male cancer. Time-dependent covariate analyses for female breast cancer yielded a relative risk for glatiramer acetate of 3.10 (95% CI, 0.86-11.1) and 0.52 (95% CI, 0.07-4.05) for beta-interferons. For IVIg, the analyses were uninformative. Our findings indicate that cancer incidence is significantly lower in female MS patients than in the general population. Female MS patients treated with glatiramer acetate showed an elevated rate of breast cancer and all MS patients treated with beta-interferons showed an elevated risk of non-breast cancers though not statistically significant (p = 0.122 and 0.072, respectively). Further study is needed to assess possible associations between long-term exposure to the novel immunomodulatory treatments in MS and rate of cancer.
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Sacker School of Medicine, Tel Aviv University, Tel-Aviv, Israel. achiron@post.tau.ac.il
authors.forename: Anat
authors.initials: A
authors.lastname: Achiron
authors.forename: Yoram
authors.initials: Y
authors.lastname: Barak
authors.forename: Mitchell
authors.initials: M
authors.lastname: Gail
authors.forename: Matilda
authors.initials: M
authors.lastname: Mandel
authors.forename: David
authors.initials: D
authors.lastname: Pee
authors.forename: Rajeev
authors.initials: R
authors.lastname: Ayyagari
authors.forename: Zeev
authors.initials: Z
authors.lastname: Rotstein
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D000068717:Glatiramer Acetate; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015994:Incidence; D016899:Interferon-beta / Q000627:therapeutic use; D007557:Israel; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000188:drug therapy; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D010455:Peptides / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000276:Adjuvants, Immunologic; D016756:Immunoglobulins, Intravenous; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta