{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T20:34:59Z","timestamp":1773952499990,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T00:00:00Z","timestamp":1512518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Several environmental and lifestyle factors have been associated with multiple sclerosis (MS) risk, including some pharmacological treatments. We systematically reviewed the literature on prescription drug exposure and MS risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Six databases were searched for original observational studies reporting drug exposure and MS risk published before 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen articles fulfilled inclusion criteria. Exposure to neither amiloride nor valproic acid was associated with MS (adjusted hazard ratio (adj.HR\u00a0=\u00a01.34;95% CI:0.81\u20132.20; adj.HR\u00a0=\u00a01.30;95%CI:0.44\u20133.80, respectively). Four studies explored oral contraceptive exposure and reported no association with MS; while a single study found an increased risk (odds ratio [adj.OR]\u00a0=\u00a01.52;95%CI:1.21\u20131.91). While penicillin exposure was associated with reduced risk of developing MS (adj.OR\u00a0=\u00a00.5;95%CI:0.3\u20130.9), a later study observed an elevated risk for penicillin (adj.OR\u00a0=\u00a01.21;95%CI:1.10\u20131.27) and all antibiotics (adj.OR\u00a0=\u00a01.41;95%CI:1.29\u20131.53), which was potentially attributed to underlying infection. Anti\u2010tumor necrosis factor\u2010alpha (TNF\u03b1) was not associated with MS risk in persons with inflammatory bowel disease (standard morbidity ratio\u00a0=\u00a04.2;95%CI:0.1\u201323.0) and arthritis (standardized incidence ratio\u00a0=\u00a01.38;95%CI:0.69\u20132.77); however, men exposed to anti\u2010TNF\u03b1 who also had arthritis and individuals with ankylosing spondylitis were at an increased risk (standardized incidence ratios\u00a0=\u00a03.91;95%CI:1.47\u201310.42 and 3.48;95%CI:1.45\u20138.37, respectively). A reduced risk of MS was observed with exposure to the beta2\u2010adrenergic agonist fenoterol (adj.OR\u00a0=\u00a00.58;95%CI:0.45\u20130.76), and the sedating histamine 1\u2010receptor antagonists (adj.OR\u00a0=\u00a00.2;95%CI:0.1\u20130.8), but not the non\u2010sedating equivalent (adj.OR\u00a0=\u00a00.8;95%CI:0.4\u20131.6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The suggestion that some drugs may prevent MS is intriguing and warrants further study. In addition, further pharmacovigilance is needed to assess the safety of anti\u2010TNF\u03b1 drugs in specific populations in the context of MS risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.4357","type":"journal-article","created":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T08:26:46Z","timestamp":1512548806000},"page":"133-139","source":"Crossref","is-referenced-by-count":10,"title":["Drug exposure and the risk of multiple sclerosis: A systematic review"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7696-491X","authenticated-orcid":false,"given":"Heather Y.","family":"Yong","sequence":"first","affiliation":[{"name":"University of British Columbia  Canada"},{"name":"Faculty of Medicine Djavad Mowafaghian Centre for Brain Health, University of British Columbia  Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9081-1522","authenticated-orcid":false,"given":"Kyla A.","family":"McKay","sequence":"additional","affiliation":[{"name":"University of British Columbia  Canada"},{"name":"Faculty of Medicine Djavad Mowafaghian Centre for Brain Health, University of British Columbia  Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cole G. 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