A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system which is associated with numerous comorbidities. These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.

Real‐world experience of ocrelizumab in multiple sclerosis in a Spanish population

“…In practice, anti‐CD20 therapy is frequently selected for patients with MS and other autoimmune diseases, so this category could have been overestimated in our study. Comorbidities are linked to faster neurological deterioration 14 . However, in our study, comorbidities did not influence the possibility of achieving NEDA status, disability progression, or AEs.…”

“…One of the major strengths of real‐world studies is that they provide information about patients with different comorbidities and prior treatments, who are not always included in clinical trials. In our study, the most common comorbidities were cardiovascular risk factors, autoimmunity, and mood disorders, with a similar profile as described in previous studies 6,14 but with a lower frequency of both cardiovascular risk factors and mood disorders since we only considered relevant conditions if they were under pharmacological treatment, caused complications, or influenced the patient’s disability or quality of life. In practice, anti‐CD20 therapy is frequently selected for patients with MS and other autoimmune diseases, so this category could have been overestimated in our study.…”

Multiple Sclerosis and SARS-CoV-2 Vaccination: Considerations for Immune-Depleting Therapies

“…The emergence of novel coronavirus infectious disease 2019 (COVID- 19), a complex clinical syndrome caused by severe acute respiratory disease type-2 (SARS-CoV-2), poses an ongoing challenge for neurologists caring for people with multiple sclerosis (pwMS) [1]. Uncertainty and anxiety are frequently expressed by the patients and caregivers and are underpinned by the question of whether MS as an independent comorbidity and the use of immunotherapies are associated with an increased risk of severe COVID-19 infection [2,3]. The considerations are justified because inflammation is an integral part of disease pathogenesis, infections can exacerbate MS-related disease activity, and pwMS are at risk of life-threatening infections [4].…”

Die Corona-Pandemie und Multiple Sklerose: Impfungen und deren Implikationen für Patienten – Teil 1: Empfehlungen

“…Infektionen bergen generell ein Risiko für MS-Patienten, da sie nicht nur einen Pseudoschub auslösen können, sondern auch mit Krankheitsprogression und reduzierter Lebenserwartung assoziiert sind [ 40 , 46 , 82 ]. Dieses infektionsassoziierte Risiko kann sich durch entsprechende Begleiterkrankungen und krankheitsmodifizierende Therapien (DMTs) nochmals weiter erhöhen [ 23 , 39 , 54 , 62 , 81 ]. Darüber hinaus existieren verschiedene Theorien zur Beteiligung von Infektionen an der Immunpathogenese der MS. Diese umfassen u. a. folgende Mechanismen: „molecular mimicry“, „bystander activation“ und „epitope spreading“ [ 44 ].…”

“…Insgesamt scheinen jedoch Risikofaktoren wie Alter, Behinderungsgrad (EDSS) und Komorbiditäten für den Verlauf bzw. die Schwere einer SARS-CoV-2-Infektion viel entscheidender zu sein, als DMTs [ 7 , 10 , 23 , 38 , 39 , 41 , 62 ]. Auf dem bisherigen Wissensstand aufbauend wird gemäß den jeweiligen regionalen Empfehlungen einheitlich die Fortführung immunmodulatorischer Therapien wie bisher empfohlen.…”