Exploring polypharmacy phenomenon in newly diagnosed relapsing–remitting multiple sclerosis: a cohort ambispective single-centre study

Abstract

Aims: We aimed to examine the frequency of polypharmacy in a large cohort of patients at the time of diagnosis of relapsing–remitting multiple sclerosis (RRMS) and to explore its effects on discontinuation of first disease-modifying treatment (DMT) using survival analysis. Methods: This was a cohort ambispective single-centre study. We enrolled RRMS patients starting their first DMT between 1st January 2013 and 31st December 2015. According to the number of medicines prescribed (except DMTs), we divided the patients into three groups: no-poly RRMS, minor-poly RRMS (from one to three medications), and major-poly RRMS (more than three medications). Results: A total of 392 RRMS patients were enrolled (mean age 41.1). The minor-poly RRMS group included 61 patients (15.6%) and the major-poly RRMS group included 112 (28.6%). Individuals in these groups were older and had higher median body mass index (BMI) than patients in the no-poly RRMS group ( p < 0.05). Upon multinomial regression analysis, older age at onset was associated with minor and major polypharmacy (OR 1.050, CI 1.010–1.093, p = 0.015 and OR 1.063, CI 1.026–1.101, p = 0.001, respectively) and higher BMI was associated with major polypharmacy (OR 1.186, CI 1.18–1.29, p = 0.001). The rates of discontinuation of first DMT were similar among the three groups (50.7% for no-Poly RRMS, 50.8% for minor-Poly RRMS, and 53.3% for major-Poly RRMS, p = 0.264). At log-Rank test, there were no differences among the three groups ( p = 0.834). Conclusion: Polypharmacy was more common in older RRMS patients with high BMI.

Screening for severe drug-drug interactions in patients with multiple sclerosis: A comparison of three drug interaction databases

“…Furthermore, we found severe pDDIs more frequently in MS patients with a lower educational level and in patients who were not in a partnership. This is in line with previous studies by our group and others showing that with older age and the presence of comorbidities, the number of drugs taken increases on average (Frahm et al, 2019;Frahm et al, 2020b;Zanghì et al, 2021;Bachmann et al, 2022) and so does the risk of pDDIs (Debus et al, 2022). Our analysis also complements the results of studies not related to MS. An Irish study of elderly community dwellers found that patients with a higher educational level were less likely to have severe pDDIs (Hughes et al, 2021).…”

Risk for Cardiovascular Adverse Events Associated With Sphingosine-1-Phosphate Receptor Modulators in Patients With Multiple Sclerosis: Insights From a Pooled Analysis of 15 Randomised Controlled Trials

“…Late-onset multiple sclerosis (LOMS) is defined as symptoms initiating after the age of 50 ( 53 ). Comparing with adult-onset multiple sclerosis (AOMS) patients, LOMS patients had significantly more cardiac risk factors, such as heart failure, coronary heart disease and high blood pressure ( 54 , 55 ), with more combination medications ( 56 ). While the incidence of second- or third-degree AV blocks was significantly higher in older patients (≥ 50 years vs. 35–49 years; p = 0.014) after the first dose of fingolimod in a current observational study ( 57 ).…”

Cost-effectiveness analysis of rituximab versus natalizumab in patients with relapsing remitting multiple sclerosis

“…Furthermore, as age increases and underlying diseases appear in the patients with MS, the prevalence of polypharmacy (use of multiple drugs) becomes more common in older RRMS patients. It was shown in a study that 28.6% of elderly patients used multiple drugs [ 20 ]. thus, a balance should be made between the risks of drug use and effectiveness in patients with LORRMS due to population aging and the presence of underlying diseases as well as the prevalence of polypharmacy [ 21 ].…”