DMTs Are Associated With Reduced Stroke Risk in Patients With MS

LOS ANGELES—Among patients with multiple sclerosis (MS), treatment with disease-modifying therapy is associated with a significantly decreased likelihood of ischemic stroke, compared with no disease-modifying therapy, according to a study presented at the 70th Annual Meeting of the American Academy of Neurology.

Stroke is a major cause of morbidity and mortality. One-third to one-half of stroke survivors have post-stoke disability. Autoimmune diseases are associated with an increased risk of ischemic stroke. To examine the role of disease-modifying therapy in the prevention of ischemic stroke in MS, Asad Ikram, MD, a clinical research fellow in the Department of Neurology at the University of New Mexico School of Medicine in Albuquerque, and colleagues conducted a nationwide, case–control, population-based study.

Investigators extracted data from the Cerner’s Health Facts database and used ICD-9/10 codes to identify all patients diagnosed with MS between 2000 and 2016. The researchers identified patients with MS who had an ischemic stroke and categorized them as having received disease-modifying therapy or not. They excluded patients younger than 18 and patients for whom they did not have information about sex.

The investigators used multiple logistic regression to evaluate the likelihood of ischemic stroke in patients treated with disease-modifying therapy. In the final model, they also adjusted for patients’ baseline characteristics and medications.

In all, Dr. Ikram and colleagues identified 57,769 patients with a diagnosis of MS, 1,349 of whom had a CT-confirmed ischemic stroke (2.34%).

The study group (ie, patients with ischemic stroke who were receiving disease-modifying therapy) included 126 patients (89 females), and the control group (ie, patients with ischemic stroke who had not received disease-modifying therapy) included 1,002 patients.

Patients not treated with disease-modifying therapy were approximately twice as likely to have an ischemic stroke, compared with patients treated with disease-modifying therapy (odds ratio = 1.91).

After controlling for covariates (eg, smoking, hypertension, diabetes, heart failure, atrial fibrillation, age, and sex), the likelihood of ischemic stroke remained higher in the untreated group.

“This study suggests that the early treatment of MS with disease-modifying therapies may reduce the risk of ischemic stroke in the MS population,” said Dr. Ikram and colleagues.

—Jake Remaly