Novel Multiple Sclerosis Agents-Associated Cardiotoxicity: A Real-World
Pharmacovigilance Study
Abstract
Background: Emerging novel therapeutics have been developed to hamper
the progression of multiple sclerosis. However, the adverse events
related to these new agents remain largely unknown. Therefore, we sought
to investigate the cardiovascular complications of these drugs. Methods:
Utilizing data from the U.S. Food and Drug Administration Adverse Events
Reporting System, we comprehensively evaluated the cardiovascular
complications of the newly FDA approved anti-multiple sclerosis agents.
Disproportionality signal analysis was conducted by measuring reporting
odds ratio (ROR) with 95% confidence interval of all the cardiovascular
adverse events adverse events since approval till 2021. Results: After
vetting the newly approved agents for multiple sclerosis, CD20 and CD25
inhibitors and sphingosine-1-phosphate receptors agonists were the
latest approved medications for multiple sclerosis since 2015. Two CD20
(ocrelizumab, ofatumumab) and one CD25 inhibitors (daclizumab) were
significantly associated with multiple cardiovascular adverse events.
Among all the cardiotoxic events; coronary artery disease, cardiac
failure and atrial fibrillation were the most predominant among CD20 or
CD25 blockers. Interestingly, Sphingosine-1-phosphate receptors agonists
showed much fewer reported cardiac adverse events. However, fingolimod
and siponimod were associated with significant bradycardia. Conclusions:
Our data revealed the new agents prescribed for multiple sclerosis have
cardiotoxic effects, including not only the known adverse effects
observed effects for S1P receptor modulators but also undefined
cardiovascular complications associated with CD20 and CD25 inhibitors.
These findings potentially instigate further studies to personalize
prescribing these agents for multiple sclerosis based on patient’s
cardiovascular profile.