Comorbidities raise risk of disease activity, disability progression
Large study of trial patients finds need to treat MS by also treating other ills
People with multiple sclerosis (MS) who have multiple comorbidities, or co-occurring health problems, are more likely to experience disease activity and disability progression, according to a new analysis.
Results indicate the risk of MS disease activity rises in patients who have at least one psychiatric diagnosis, as well as in those with at least two heart-related health problems.
Based on these findings, researchers emphasized that MS clinicians need to help patients address their comorbidities — not just for the sake of managing those conditions, but also as a vital part of treatment for MS itself.
The study, “Comorbidity and Disease Activity in Multiple Sclerosis,” was published in JAMA Neurology.
Comorbidities are co-occurring problems like high blood pressure, depression
Comorbidities can be quite common for people with MS, from high blood pressure and cardiovascular disease to diabetes and depression. The presence of these other health conditions can impact MS outcomes, if, for example, they cause a person to resist  starting on MS treatments. But studies examining this link are still limited.
Scientists in Canada and the U.S. analyzed findings from 17 Phase 3 clinical trials, encompassing data covering nearly 17,000 MS patients who were followed for at least two years.
Nearly half of these people (45.4%) had at least one diagnosed comorbidity. Over the course of two years, 61% of the them also had evidence of disease activity, meaning they experienced an MS relapse, worsened disability, and/or new evidence of inflammation on MRI scans.
Using mathematical models that accounted for factors such as age, sex, disability levels, treatment, and previous MS activity, the researchers looked for statistical associations between comorbidities and evidence of MS activity. Results showed that, compared to patients without comorbidities, those with three or more comorbidities had a 14% greater risk of experiencing any disease activity.
21% higher risk of disease activity with cardiometabolic ills like hypertension
The risk was also significantly higher, by 21%, in people with two or more cardiometabolic comorbidities, including ischemic heart disease (when the heart is not getting enough blood), high blood pressure, and cerebrovascular conditions. Additionally, individuals with at least one psychiatric comorbidity, such as depression, had a 7% increased risk of MS activity compared with those without any diagnosed psychiatric issues.
“These findings persisted for cardiometabolic conditions and depression after adjusting for multiple demographic and clinical factors,” the researchers noted.
Additional analyses showed that patients with two or more comorbidities, those with two or more cardiometabolic conditions, and those with depression all had a greater risk of disability worsening. More comorbidities also significantly associated with a higher risk of relapses, but no significant association was seen between comorbidities and MRI-based measures of disease activity.
“A greater number of comorbidities, including burden of cardiometabolic and psychiatric comorbidities, were associated with a greater risk of relapse and disability worsening,” the scientists concluded.
The team added that this result “suggests that the effects of higher comorbidity burden could be greater and have consequences for the clinical care for people with MS beyond the comorbidities.”
Based on this finding, they emphasized that managing comorbidities is an important part of managing MS itself, noting that “the prevention and management of comorbidities should be a pressing clinical concern.”
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