More comorbidity is associated with worse clinical outcomes in MS

In phase 3 clinical trials of disease-modifying therapies (DMTs) for MS, comorbidity and a higher burden of comorbidity were associated with worse clinical outcomes in participants. Comorbidity affected event rates in these phase 3 trials. In clinical practice, the comorbidity burden may be higher still, which makes its prevention and management all the more urgent.

A recent pooled analysis, conducted by the same investigators, of comorbidities in 17 phase 3 trials showed that 25% had 1, 11% had 2, and 6% had 3 or more comorbidities [1]. Consequently, Dr Amber Salter (University of Texas Southwestern, TX, USA) and colleagues conducted a meta-analysis of data from 17 phase 3 clinical trials of DMTs, including 16,794 participants with MS. The primary outcome was time to first evidence of disease activity over 2 years [2].

Over 2 years of follow-up, 61% of participants in the pooled trials had evidence of disease activity (EDA) (61.0%; 95%CI: 56.2–66.3%; I2=97.9). Having ≥3 comorbidities was associated with a 14% increased hazard of disease activity (HR 1.14; 95% CI 1.02–1.28) compared with those with no comorbidity. Patients with ≥2 cardiometabolic conditions had a 21% increased hazard of disease activity (HR 1.21; 95% CI 1.08–1.37). A psychological disorder was associated with a 7% higher hazard of disease activity (HR 1.07; 95% CI 1.02–1.14). Depression and ischaemic heart disease were individually associated with an increased EDA risk.

For disability worsening, having ≥3 comorbidities was associated with a 31% increase in disability worsening risk (HR 1.31; 95% CI 1.05–1.64). Patients with ≥2 cardiometabolic conditions had a 34% increased risk (HR 1.34; 95% CI 1.12–1.60). Depression, ischaemic heart disease, and hyperlipidaemia were each associated with disability worsening. All comorbidities together as well as psychiatric comorbidities were associated with relapse risk, except for cardiometabolic diseases. Among comorbidities, no association was found with lesions on imaging.

1. Salter A, et al. 2024;103(8):e209515.
2. Salter A, et al. The association of comorbidities and disease activity in phase III clinical trials for disease-modifying therapies in multiple sclerosis. Abstract O005, ECTRIMS 2024, 17–20 October 2024, Copenhagen, Denmark.

Medical writing support was provided by Michiel Tent
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Posted on 25 September 202425 September 2024