Assessing association of comorbidities with treatment choice and persistence in MS

Laroni, Alice; Signori, Alessio; Maniscalco, Giorgia Teresa; Lanzillo, Roberta; Russo, Cinzia Valeria; Binello, E; Fermo, Salvatore Lo; Repice, Annamaria; Annovazzi, Pietro; Bonavita, Simona; Clerico, Marinella; Baroncini, Damiano; Prosperini, Luca; Gioia, Sara La; Rossi, Silvia; Cocco, Eleonora; Frau, Jessica; Clerici, Valentina Torri; Signoriello, Elisabetta; Sartori, Arianna; Zarbo, Ignazio Roberto; Rasia, Sarah; Cordioli, Cinzia; Cerqua, Raffaella; Sapio, Alessia Di; Lavorgna, Luigi; Pontecorvo, Simona; Barrilà, Caterina; Saccà, Francesco; Frigeni, Barbara; Esposito, Sabrina; Ippolito, Domenico; Gallo, Fabio; Sormani, Maria Pia

doi:10.1212/wnl.0000000000004686

Cited by 55 publications

(39 citation statements)

References 27 publications

(23 reference statements)

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“…Specific comorbidities such as ischemic heart disease and anxiety were associated with a lower likelihood of DMT initiation (69). Interestingly, comorbidities were not significantly associated with the choice of the first DMT but were significantly associated with a higher risk of switching from the first DMT due to intolerance (70).…”

Section: Effects On Treatment-related Topicsmentioning

confidence: 93%

Comorbidity in Multiple Sclerosis

2020

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Comorbidities in patients with multiple sclerosis (MS) has become an area of increasing interest in the recent years. A comorbidity is defined as any additional disease that coexists in an individual with a given index disease and that is not an obvious complication of the index disease. The aim of this review is to describe the current evidence regarding the range of comorbidities in the population with MS reported in different countries and the current knowledge about the influence of comorbidities on the clinical features and therapeutic challenges in MS. Certain comorbidities are more prevalent in people with MS such as depression, anxiety, cerebro-and cardiovascular diseases, and certain autoimmune disorders such as diabetes, thyroid disease, and inflammatory bowel disease. A previous perception of a trend toward a lower overall risk of cancer in patients with MS appears to be challenged, but there is no evidence on any higher occurrence of malignancies in the population with MS. Comorbidities may modify the clinical presentation of MS, and have implications for treatment choice, adherence, and outcome. Several comorbid conditions are associated with increased disability progression, including diabetes, hypertension, and chronic obstructive pulmonary disease. Comorbidities are common in MS from the time of diagnosis and may account for some of the heterogeneity observed in MS, including diagnostic delay, clinical presentation, degree of disability progression, rate of health care utilization, working ability, employment status, and quality of life. Coexisting diseases and polypharmacy increase the complexity of patient management and poses major challenges, particularly with the increasing number of immunosuppressive disease-modifying therapies.

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Section: Effects On Treatment-related Topicsmentioning

confidence: 93%

Comorbidity in Multiple Sclerosis

2020

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“…Comorbidities classification was detailed in a previous paper. 4 First DMT, date of DMT initiation, date of switch to a new DMT and the new DMT, date of stop and re-start (if the patient re-started the same DMT), and date of last follow-up were recorded. To reduce data complexity, the reason for DMT switch/stop was grouped into two classes: lack of efficacy or intolerance/safety.…”

Section: Methodsmentioning

confidence: 99%

“…DMTs, patients' preferences, and co-existing comorbidities. 3,4 Recently, new oral compounds have been licensed, 5 making the choice even more complex.…”

Section: Determinants Of Therapy Switch In Multiple Sclerosis Treatmementioning

confidence: 99%

Determinants of therapy switch in multiple sclerosis treatment-naïve patients: A real-life study

et al. 2018

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“…In a study of 10,698 Canadians with incident MS, the likelihood of starting a disease-modifying therapy decreased as the number of comorbidities increased [36]. In an Italian study of 2,076 newly-diagnosed persons with MS, the presence of comorbidity was associated an increased hazard of switching therapies due to intolerance (hazard ratio 1.42; 1.07-1.87), particularly when the therapy chosen was interferon-beta [62].…”

Section: Figure 1 Factors That May Influence Outcomes In Multiple Scmentioning

confidence: 99%

Comorbidity in multiple sclerosis: Past, present and future

Marrie

2019

CIM

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Purpose: Multiple sclerosis (MS) is an inflammatory and degenerative condition affecting the central nervous system. Like many neurologic diseases, it is chronic and incurable, and confers a substantial burden on affected individuals, their families and society. Although many individuals suffering from a serious chronic disease also suffer from comorbid conditions, the important consequences of their interaction often receive little attention. This was particularly true for MS two decades ago. Broadening our perspective by better understanding the effects of comorbidity on an individual with a particular chronic disease offers us an opportunity to improve understanding of prognosis, personalize disease management, develop new therapeutic approaches and illuminate the pathophysiology of disease. Source: Studies examining the incidence, prevalence and outcomes related to comorbidity in MS will be discussed, along with areas requiring further investigation. Conclusion: Comorbidity is highly prevalent in MS throughout the disease course. Comorbid conditions, including depression, anxiety, hypertension, hyperlipidemia, diabetes and chronic lung disease, adversely affect a broad range of outcomes. Less is known about the effects of MS on outcomes related to these comorbid conditions. These findings highlight an urgent need to determine how to best prevent and treat comorbidity in MS.

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Assessing association of comorbidities with treatment choice and persistence in MS

Abstract: Comorbidities at diagnosis should be taken into account at the first treatment choice because they are associated with lower persistence on treatment.

Cited by 55 publications

References 27 publications

Comorbidity in Multiple Sclerosis

Comorbidity in Multiple Sclerosis

Determinants of therapy switch in multiple sclerosis treatment-naïve patients: A real-life study

Comorbidity in multiple sclerosis: Past, present and future

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