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 (DIR) Return to: NOVANTRONE (mitoxantrone)
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       #Post#: 1796--------------------------------------------------
       Older MS drugs {Novantrone, Imuran, Cytoxan] may boost cancer ri
       sk 
       By: agate Date: August 24, 2017, 7:56 pm
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       From MedPage Today, August 14, 2017:
       [quote]Older MS Drugs May Boost Cancer Risk
       But MS alone doesn't raise cancer risk, Sicilian study finds
       by Thomas Walsh, MedPage Today Intern
       Patients with multiple sclerosis who took older immune
       suppressors had an increased risk of cancer, data from a
       Sicilian study showed.
       In a single-center cohort, MS patients exposed to three older
       immunosuppressant drugs -- azathioprine (Imuran), mitoxantrone
       (Novantrone), and cyclophosphamide (Cytoxan) -- had a
       significantly greater risk of cancer compared with those not
       exposed (HR 11.05, 95% CI 1.67-73.3, P=0.013), Paolo Ragonese,
       MD, of the University of Palermo in Italy and colleagues,
       reported online in BMC Neurology.
       The risk seemed to be driven by azathioprine and mitoxantrone,
       as there were no cancer deaths in those treated with
       cyclophosphamide in this study, the researchers said.
       Even though newer drugs that are thought to have a better safety
       profile are now on the market, there are still MS patients "who
       do not respond to available drugs and experience an unfavorable
       disease course, rapidly accumulating disability, or patients who
       have lack of tolerance and need therefore a therapeutic
       alternative," the researchers wrote.
       "In all of these patients, a strict long-term follow-up must be
       planned to avoid life-threatening conditions," they said.
       Ragonese and colleagues studied 531 MS patients exposed to
       immune suppressants from 1994 to 2011 for a mean of nine years,
       and compared them with 531 MS patients who didn't take these
       drugs. Both MS groups consisted of 346 women and 185 men between
       ages 18 and 54. The researchers also compared cancer incidence
       in MS patients with cancer incidence in the general population
       of Sicily in similar age groups.
       They found that those treated with azathioprine (median exposure
       5 years) or mitoxantrone (median exposure 1 year) had a fourfold
       increased risk of cancer compared with MS patients who were not
       exposed. Among 346 patients treated with azathioprine, seven
       developed cancer in various sites (three breast, two gut, one
       brain, one ovary). Among 262 patients treated with mitoxantrone,
       six developed cancer (three leukemia, one gut, one lung, one
       pancreas).
       "The association between the exposure to mitoxantrone and
       various forms of adult onset leukemia has been seen across Italy
       and elsewhere," said Jerry Wolinsky, MD, of the McGovern Medical
       School at UTHealth in Houston, who was not involved in the
       study. "That, plus its cardiotoxicity, has resulted in limiting
       the total dose that's supposed to be given and the fact that
       mitoxantrone came and went on the therapeutic horizon fairly
       quickly."
       There was no association between cancer and cyclophosphamide
       exposure, but this accounted for the smallest group and
       follow-up wasn't as long, the researchers noted.
       When compar[ed] with the general Sicilian population, MS
       patients on immunosuppressants had a fourfold higher rate of
       cancer -- but there was no difference in cancer incidence for MS
       patients who didn't take the drugs, they found. (SIR 0.97, CI
       0.96-0.98). This is consistent with data found in other national
       registries, Wolinsky said.
       Jeffrey Cohen, MD, of the Cleveland Clinic, who wasn't involved
       in the study, said it makes the "important point that the risk
       of cancer does not appear to be increased by MS alone."
       The study was limited because the authors couldn't account for
       confounding environmental risk factors for cancer like smoking,
       given the data available. Also, all subjects were from the same
       geographic area, which could limit the applicability of the
       results to groups outside of Sicily.
       At the same time, however, the results could apply to patients
       without MS who take these drugs. Azathioprine is still used in
       patients with neuromyelitis optica, and neurologists should be
       cautious with this population, said Jonathan Howard, MD, of New
       York University, who was not involved with the study.
       Mitoxantrone and azathioprine are also more commonly used in
       patients with rheumatologic disorders, particularly rheumatoid
       arthritis, and other conditions of unknown etiology like
       sarcoidosis, Wolinsky noted.
       Ragonese disclosed financial relationships with Merck Serono,
       Biogen, Novartis, Sanofi Genzyme, and Teva.
       Co-authors disclosed financial relationships with Boehringer
       Ingelheim, Biogen, Teva, Merck Serono, and Novartis.
       Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate
       Professor, Weill Cornell Medical College and Dorothy Caputo, MA,
       BSN, RN, Nurse Planner[/quote]
       The article can be seen here
 (HTM) https://www.medpagetoday.com/Neurology/MultipleSclerosis/67263?xid=nl_mpt_DHE_2017-08-15&eun=g345846d0r&pos=1.
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