Comorbidities in Multiple Sclerosis: Effects on DMTs, the Treatment Team, and More – Neurology Advisor

Multiple sclerosis (MS) is associated with a compendium of comorbid conditions that exert a significant influence on patient morbidity, mortality, and quality of life (QoL). The chronic, inflammatory nature of MS contributes to a high rate of comorbidities, which in turn contributes to greater MS disability and a poorer disease course.1 Findings from a 2016 study conducted in Australia suggested that people with MS have a much higher risk for certain conditions such as hypertension, dyslipidemia, asthma, psoriasis, eczema, and anemia compared with the general Australian population.1

The patterns of comorbidities in MS are often predictive of outcomes. Kowalec, et al2 reported that patients with MS with comorbid migraine or hyperlipidemia and patients with a high comorbidity burden consisting of 3 or more diagnosed conditions were more likely to experience MS over a 2-year period.

As Ruth Ann Marrie, MD, PhD, director of the multiple sclerosis clinic at the University of Manitoba Health Sciences Centre in Winnipeg, Canada, and co-investigator in multiple studies on MS comorbidity, told Neurology Advisor, “Several comorbid conditions are associated with greater disability progression including depression, diabetes, hypertension, and hyperlipidemia.” Psychiatric comorbidities, including depression, anxiety, and bipolar disorder have higher reported prevalence in the MS population, although studies report widely varied estimates. A 2015 study by Marrie, et al3 found that while the incidence of all 3 psychiatric comorbidities was higher in women, the burden for depression in particular was significantly higher in men.

Managing Comorbidities

Having a higher burden of comorbidities is also associated with greater disability progression and lower QoL, as well as increased healthcare utilization and mortality, Dr Marrie said, which therapeutically suggests preventing and treating comorbidities as a means of improving outcomes. However, the range and diversity of possible comorbid conditions that patients with MS experience requires multidisciplinary care. “Comorbid conditions are often managed by other providers,” she explained. “Diabetes for example, would typically be managed by a primary care provider or endocrinologist as this condition does not fall within the usual scope of practice of a neurologist,” she said, noting that some conditions such as depression or anxiety disorders might be managed by a provider within the MS care team, a diversified group of trained individuals that also includes MS nurses, occupational therapists, physical therapists, dieticians, and social workers in addition to the neurologist. Treatment of comorbid conditions is equally important to improving MS outcomes, Dr Marrie said.

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