Co-morbidities
The burden of co-morbidities can be particularly high in patients with MS [1]. Whereas the rates of psychiatric co-morbidities seem largely stable with increasing age, the physical co-morbidities (e.g. hypertension, hyperlipidemia, diabetes) become more prevalent as MS patients get older [2,3] (see figure). According to Danish national registry data, the onset of vascular co-morbidities often occurs shortly after the diagnosis of MS [4].
Prevalence of hypertension among Canadian MS patients by age group [2,3]
It is of note that in a recent study conducted in England [5] which compared matched populations with (n= 12,251) and without MS (n= 72,572), having the condition was associated with a:
- 59% increased hazard of cerebrovascular disease
- 32% increased hazard of any macrovascular disease
- 28% increased hazard of acute coronary syndrome
- 1.5-fold increased hazard in cardiovascular disease mortality.
A higher risk of cardiovascular disease for patients with MS was noted even after accounting for traditional vascular risk factors [5]. While this observation needs further investigation, it seems it would not be unique to MS [6] since it has also been described for other immune-mediated and inflammatory diseases like psoriasis and rheumatoid arthritis [5].
Co-morbid conditions may influence disease outcomes, including relapses, disability progression or neurodegenerative tissue injury [2,3,6,7]. Additionally, co-morbidities may have other negative consequences such as diagnostic delays, increased mortality, or reduced quality of life [2,3].
Furthermore, the presence of co-morbidities appears to affect treatment decisions in MS. For example, an analysis of Canadian administrative data (n=10,698) found the likelihood of initiating a disease-modifying therapy decreased with increasing numbers of comorbid conditions [8].
Appropriate management of co-morbidities in the management of patients with MS is important [6].
Polypharmacy
Prof. Magd Zakaria
Management of MS: What if the burden of co-morbidities is high?
References
- Vaughn CB et al. Nat Rev Neurol 2019; 15(6): 329-42. Return to content
- Marrie RA et al. Nat Rev Neurol 2017; 13(6): 375-82. Return to content
- Marrie RA et al. Mult Scler 2012; 18(9): 1310-19. Return to content
- Thormann A et al. J Neurol 2016; 263(12): 2484-93. Return to content
- Palladino R et al. JAMA Neurol 2020; 77(7): 820-8. Return to content
- Salter A et al. Neurology 2020; 95(5): e446-56. Return to content
- Jakimovski D et al. Eur J Neurol 2019; 26(1): 87-e8. Return to content
- Zhang T et al. Neurology 2016; 86(14): 1287-95. Return to content
