More comorbidity is associated with worse clinical outcomes in MS

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

A recent pooled analysis of comorbidities in 17 phase 3 trials showed that 25% of the participants had 1 comorbidity, 11% had 2 comorbidities, and 6% had 3 or more comorbidities [1]. Consequently, Dr Amber Salter (UT Southwestern, TX, USA) and colleagues conducted a meta-analysis of data from these 17 phase 3 clinical trials of DMTs, including 16,794 participants with MS [2]. The primary outcome was time to first evidence of disease activity over 2 years. Individual comorbidities considered were hypertension, hyperlipidaemia, functional heart conditions, ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, diabetes, autoimmune thyroiditis, miscellaneous autoimmune conditions, migraine, lung or skin conditions, depression, anxiety, and other psychological disorders.

Over 2 years of follow-up, 61% of the participants in the pooled trials had evidence of disease activity (EDA). Having ≥3 comorbidities was associated with a 14% increased EDA risk (HR 1.14; 95% CI 1.02–1.28) compared with those with no comorbidity. Participants with ≥2 cardiometabolic conditions had a 21% increased EDA risk (HR 1.21; 95% CI 1.08–1.37). A psychological disorder was associated with a 7% higher EDA risk (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). Participants with ≥2 cardiometabolic conditions had a 34% increased risk (HR 1.34; 95% CI 1.12–1.60). Depression and ischaemic heart disease were each associated with disability worsening (see Figure). All comorbidities together were associated with relapse risk. This was also the case for psychiatric comorbidities but not for cardiometabolic diseases. Overall, no association was found with lesions on imaging.

Figure: Individual comorbidities and associated risk of evidence of MS disease activity [2]

1. Salter A, et al. Neurology. 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, 18–20 September, Copenhagen, Denmark.

 

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Posted on 18 November 202425 November 2024