Clinical relevance: Comorbidities significantly worsen relapse rates, disability progression, and overall disease activity in MS patients.

Patients with three or more comorbidities face a 14 percent higher risk of additional disease activity. And this risk jumps to 21% with two or more cardiometabolic conditions. Psychiatric disorders, notably depression, also contribute to higher disease progression.

New research suggests that comorbidities significantly aggravate disease activity and clinical outcomes in multiple sclerosis (MS) patients. The results highlight the need for better health management for these individuals.

The findings, based on a meta-analysis of data from 17 clinical trials of disease-modifying therapies (DMTs), revealed that MS patients with higher comorbidity burdens experience:

Higher relapse rates. Accelerated disability progression. And heightened overall disease activity. Methodology

The researchers pored over individual data from nearly 16,800 MS patients pulled from trials between 2001 and 2018. The authors also spent two years in follow-up research.

The researchers wanted to find out how co-occurring health conditions — whether its hypertension, cardiovascular disease, or depression— influence disease activity in MS (if at all). The authors defined “disease activity” as a combination of confirmed relapses, disability worsening, or new lesions found through magnetic resonance imaging (MRI).

The researchers found that patients with three or more comorbidities boasted a 14 percent higher risk of encountering additional disease activity compared to those without.

Worse still:

The presence of two or more cardiometabolic conditions – such as hypertension and ischemic heart disease – bumped up that risk by 21 percent. Psychiatric disorders, especially depression, also added to increased MS activity. Depressed patients had an 11 percent higher likelihood of disease progression.

The study highlights the impact of these comorbidities on MS outcomes, with cardiometabolic and psychiatric conditions emerging as the most significant contributors. The study’s authors also suggested that better managing these comorbidities could help slow down disease progression and cut back on relapse rates.

While prior research has linked comorbidities to poorer outcomes in MS, this study appears to be one of the most comprehensive investigations to date on how certain health conditions sway MS disease activity.

Making Sense Of It

The study’s authors emphasized the need for clinicians to pay closer attention to comorbidities when treating MS patients.

“Our findings have important implications,” the authors suggested. “Clinically, cardiovascular, mental health, and chronic lung conditions are the most common comorbidities that affect people with MS throughout their disease course. While mental health conditions have a consistently high prevalence at all ages, the prevalence of cardiovascular and chronic lung conditions increases with age.”

This paper also could play a role in shaping the direction of future clinical trials. The researchers found that the burden of comorbidities in trial participants had a significant adverse effect on disease outcomes, potentially influencing the design and sample sizes of future MS trials.

They also called for more research into how effectively managing comorbidities might improve MS treatment outcomes and whether existing strategies should be reviewed.

“Our findings suggest that preventing and managing comorbidities should be a pressing concern in clinical practice,” the authors wrote. 

The study underlines the importance of a more holistic approach to MS treatment, particularly in managing cardiovascular and mental health conditions that typically accompany the disease. 

With the prevalence of these comorbidities expected to increase as the global population ages, the researchers urged healthcare professionals to develop integrated care models that address both MS and the co-occurring conditions that exacerbate it.

Further Reading

Epstein Barr Virus Linked to Multiple Sclerosis

Mediterranean Diet May Help Preserve Cognition in MS

Multiple Sclerosis During the COVID-19 Pandemic