Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review
Background: Epidemiological research indicates a heightened incidence of cerebrovascular disorders among patients with multiple sclerosis (MS). Objectives: The aim of the present systematic review was to investigate the potential association between disease modifying therapies (DMTs) and the risk of...
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| Language: | English |
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SAGE Publishing
2025-05-01
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| Series: | Therapeutic Advances in Neurological Disorders |
| Online Access: | https://doi.org/10.1177/17562864251321669 |
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| author | Maria-Ioanna Stefanou Aikaterini Theodorou Annerose Mengel Konstantinos Melanis Christos Bakirtzis Vasileios Giannopapas Dimitrios K. Kitsos Markus Kowarik Katharina Feil Dimitrios Tzanetakos Vasiliki Zouvelou Elizabeth Andreadou John S. Tzartos Sotirios Giannopoulos Georgios Tsivgoulis |
| author_facet | Maria-Ioanna Stefanou Aikaterini Theodorou Annerose Mengel Konstantinos Melanis Christos Bakirtzis Vasileios Giannopapas Dimitrios K. Kitsos Markus Kowarik Katharina Feil Dimitrios Tzanetakos Vasiliki Zouvelou Elizabeth Andreadou John S. Tzartos Sotirios Giannopoulos Georgios Tsivgoulis |
| author_sort | Maria-Ioanna Stefanou |
| collection | DOAJ |
| description | Background: Epidemiological research indicates a heightened incidence of cerebrovascular disorders among patients with multiple sclerosis (MS). Objectives: The aim of the present systematic review was to investigate the potential association between disease modifying therapies (DMTs) and the risk of stroke in MS patient populations. Data sources and methods: A systematic literature search was performed in MEDLINE and SCOPUS databases up to April 6, 2024, to identify randomized-controlled clinical trials (RCT), registry-based and cohort-studies, case-series, and case-reports reporting on acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in MS patients under different DMTs. Results: Twenty-one studies were included: 1 RCT, 6 registry-based or cohort studies, 2 case-series and 11 case-reports. Overall, DMTs appear to reduce the risk of stroke in MS patients, with DMT exposure linked to a 50% reduction of the risk of stroke compared to no DMT exposure. Although glatiramer acetate and dimethyl fumarate appear to lower the risk of stroke, concerns about fingolimod exists due to an observed elevated risk for ischemic heart disease and hypertension. Despite the absence of detected safety concerns with alemtuzumab at the MS population level, alemtuzumab-related complications, although rare, signal the need for heightened clinical vigilance. Similarly, β-interferons have been linked to life-threatening adverse events, comprising thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS). No associations between the risk of stroke and other DMTs, comprising natalizumab and teriflunomide, were detected; yet, newly approved DMTs were underrepresented. Conclusion: These findings highlight the importance of personalizing DMT selection and monitoring cardiovascular risk factors to reduce stroke risk in patients with MS. Trial registration: PROSPERO CRD42024534470. |
| format | Article |
| id | doaj-art-65cfd73d7ceb4d5fbe614921a62e89b9 |
| institution | DOAJ |
| issn | 1756-2864 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Neurological Disorders |
| spelling | doaj-art-65cfd73d7ceb4d5fbe614921a62e89b92025-08-20T03:13:07ZengSAGE PublishingTherapeutic Advances in Neurological Disorders1756-28642025-05-011810.1177/17562864251321669Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic reviewMaria-Ioanna StefanouAikaterini TheodorouAnnerose MengelKonstantinos MelanisChristos BakirtzisVasileios GiannopapasDimitrios K. KitsosMarkus KowarikKatharina FeilDimitrios TzanetakosVasiliki ZouvelouElizabeth AndreadouJohn S. TzartosSotirios GiannopoulosGeorgios TsivgoulisBackground: Epidemiological research indicates a heightened incidence of cerebrovascular disorders among patients with multiple sclerosis (MS). Objectives: The aim of the present systematic review was to investigate the potential association between disease modifying therapies (DMTs) and the risk of stroke in MS patient populations. Data sources and methods: A systematic literature search was performed in MEDLINE and SCOPUS databases up to April 6, 2024, to identify randomized-controlled clinical trials (RCT), registry-based and cohort-studies, case-series, and case-reports reporting on acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in MS patients under different DMTs. Results: Twenty-one studies were included: 1 RCT, 6 registry-based or cohort studies, 2 case-series and 11 case-reports. Overall, DMTs appear to reduce the risk of stroke in MS patients, with DMT exposure linked to a 50% reduction of the risk of stroke compared to no DMT exposure. Although glatiramer acetate and dimethyl fumarate appear to lower the risk of stroke, concerns about fingolimod exists due to an observed elevated risk for ischemic heart disease and hypertension. Despite the absence of detected safety concerns with alemtuzumab at the MS population level, alemtuzumab-related complications, although rare, signal the need for heightened clinical vigilance. Similarly, β-interferons have been linked to life-threatening adverse events, comprising thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS). No associations between the risk of stroke and other DMTs, comprising natalizumab and teriflunomide, were detected; yet, newly approved DMTs were underrepresented. Conclusion: These findings highlight the importance of personalizing DMT selection and monitoring cardiovascular risk factors to reduce stroke risk in patients with MS. Trial registration: PROSPERO CRD42024534470.https://doi.org/10.1177/17562864251321669 |
| spellingShingle | Maria-Ioanna Stefanou Aikaterini Theodorou Annerose Mengel Konstantinos Melanis Christos Bakirtzis Vasileios Giannopapas Dimitrios K. Kitsos Markus Kowarik Katharina Feil Dimitrios Tzanetakos Vasiliki Zouvelou Elizabeth Andreadou John S. Tzartos Sotirios Giannopoulos Georgios Tsivgoulis Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review Therapeutic Advances in Neurological Disorders |
| title | Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review |
| title_full | Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review |
| title_fullStr | Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review |
| title_full_unstemmed | Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review |
| title_short | Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review |
| title_sort | risk of stroke under disease modifying therapies for multiple sclerosis a systematic review |
| url | https://doi.org/10.1177/17562864251321669 |
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