Evidence map›Paper›PMID 33791892›Full record

Observational studyNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2021

Cancer risk for multiple sclerosis patients treated with azathioprine and disease-modifying therapies: an Italian observational study.

Loredana La Mantia, Maria Donata Benedetti, Milena Sant, Alessia d'Arma, Sonia Di Tella, Roberto Lillini, Laura Mendozzi, Antonio Marangi, Marco Turatti, Domenico Caputo and 1 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
1.2field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 1 country.

Loredana La MantiaUnit of Neuromotor Rehabilitation, Multiple Sclerosis Center, Fondazione Don Carlo Gnocchi IRCCS, Via Capecelatro, 66, 20148, Milano, Italy. lamantialore@gmail.com.ORCID http://orcid.org/0000-0002-5447-1612
Maria Donata BenedettiUnit of Neurology B, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Milena SantAnalytical Epidemiology and Health Impact Unit, Fondazione Istituto Nazionale dei Tumori di Milano (IRCCS), Milano, Italy.
Alessia d'ArmaUnit of Neuromotor Rehabilitation, Multiple Sclerosis Center, Fondazione Don Carlo Gnocchi IRCCS, Via Capecelatro, 66, 20148, Milano, Italy.
Sonia Di TellaUnit of Neuromotor Rehabilitation, Multiple Sclerosis Center, Fondazione Don Carlo Gnocchi IRCCS, Via Capecelatro, 66, 20148, Milano, Italy.
Roberto LilliniAnalytical Epidemiology and Health Impact Unit, Fondazione Istituto Nazionale dei Tumori di Milano (IRCCS), Milano, Italy.
Laura MendozziUnit of Neuromotor Rehabilitation, Multiple Sclerosis Center, Fondazione Don Carlo Gnocchi IRCCS, Via Capecelatro, 66, 20148, Milano, Italy.
Antonio MarangiDepartment of Neurosciences, Medicine and Movement, Università degli Studi di Verona, Verona, Italy.
Marco TurattiUnit of Neurology B, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Domenico CaputoUnit of Neuromotor Rehabilitation, Multiple Sclerosis Center, Fondazione Don Carlo Gnocchi IRCCS, Via Capecelatro, 66, 20148, Milano, Italy.
Marco RovarisUnit of Neuromotor Rehabilitation, Multiple Sclerosis Center, Fondazione Don Carlo Gnocchi IRCCS, Via Capecelatro, 66, 20148, Milano, Italy.
Don Carlo Gnocchi Foundation · ITAzienda Ospedaliera Universitaria Integrata Verona · ITFondazione IRCCS Istituto Nazionale dei Tumori · ITUniversità Cattolica del Sacro Cuore · ITUniversity of Verona · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe risk of malignancy associated with sequential disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) is uncertain. The aim of this study was to analyze the risk of cancer in patients with MS treated with azathioprine (AZA) and the influence of sequential DMTs on the risk.

methodWe retrospectively enrolled a cohort of AZA-treated MS patients followed in two Italian centers from 1987 to 2019. The ratio between observed and expected cancers in the Italian general population was calculated as standardized incidence ratio (SIR). Associations between AZA and DMTs and cancer were estimated by Cox proportional hazards model.

resultsWe identified 500 AZA-treated MS patients, followed for a median time of 9.7 (0.1-45.7) years: 61.8% of them were treated with DMTs. We found 22 cases of cancer (4.4%). The SIR was 1.14 (95% CI 0.98-1.29), not significantly increased in comparison with the general population. However, the risk was significantly higher in the quintiles of age 32-45, SIR 1.21 (95% CI 1.21-1.42), and 46-51, SIR 1.11 (95% CI 1.11-1.32) than in older cases. Age at AZA treatment onset was the only covariate significantly related to cancer incidence (HR = 1.049, 95% CI 1.007-1.093). The exposure to other DMTs did not modify the risk.

conclusionThe risk of malignancy in MS patients after AZA was similar to that of the general population and did not change with other DMTs sequential treatments. The increased risk in the younger ages should be considered in treatment assessment.

Indexed as

Multiple SclerosisNeoplasmsAdultAgedAzathioprineHumansMiddle AgedRetrospective StudiesRiskAzathioprineAzathioprineCancerDisease-modifying therapiesMultiple sclerosis

Identifiers

PMID33791892
OpenAlexW3141265425

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.