Evidence map›Paper›PMID 40416416›Full record

ReviewTherapeutic advances in neurological disorders2025

Risk of stroke under disease modifying therapies for multiple sclerosis: a systematic review.

Maria-Ioanna Stefanou, Aikaterini Theodorou, Annerose Mengel, Konstantinos Melanis, Christos Bakirtzis, Vasileios Giannopapas, Dimitrios K Kitsos, Markus Kowarik, Katharina Feil, Dimitrios Tzanetakos and 5 more

Abstract readReview
In one paragraph

Review in Therapeutic advances in neurological disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

15 authors.

Maria-Ioanna StefanouSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0002-2305-6627
Aikaterini TheodorouSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0001-7229-2610
Annerose MengelDepartment of Neurology and Stroke, University of Tübingen, Hoppe-Seyler-Straße 3, Tübingen 72076, Germany.ORCID https://orcid.org/0000-0002-2399-3020
Konstantinos MelanisSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0002-3224-3053
Christos BakirtzisSecond Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece.ORCID https://orcid.org/0000-0002-4737-3707
Vasileios GiannopapasSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Dimitrios K KitsosSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0003-0722-9329
Markus KowarikDepartment of Neurology and Stroke, University of Tübingen, Tübingen, Germany.
Katharina FeilDepartment of Neurology and Stroke, University of Tübingen, Tübingen, Germany.
Dimitrios TzanetakosSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Vasiliki ZouvelouFirst Department of Neurology, "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Elizabeth AndreadouFirst Department of Neurology, "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
John S TzartosSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Sotirios GiannopoulosSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0001-7443-5179
Georgios TsivgoulisSecond Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0002-0640-3797

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

cardiovascular risk factorscerebrovascular diseasedisease modifying therapiesintracerebral hemorrhagemultiple sclerosisstroke

Identifiers

PMID40416416
PMCPMC12099087

What Socratic holds

Textmetadata
LicenceCC BY
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 Socratic graph.