The risk of polypharmacy, comorbidities and drug–drug interactions in women of childbearing age with multiple sclerosis

Abstract

Background and Aims: Multiple sclerosis (MS) is the most common neuroimmunological disease of the central nervous system in young adults. Despite recommended contraception, unplanned pregnancies can occur in women of childbearing age with MS. MS- and comorbidities-related multimedication in these patients represents a potential risk. We aimed to raise awareness regarding the frequency of polypharmacy and drug–drug interactions (DDIs) in female MS patients of childbearing age. Methods: Sociodemographic, clinical and pharmaceutical data were collected through patient records, clinical investigations and structured patient interviews of 131 women with MS. The clinical decision support software MediQ was used to identify potential DDIs. A medication and DDI profile of the study population was created by statistical analysis of the recorded data. Results: Of the 131 female MS patients, 41.2% were affected by polypharmacy (concurrent use of ⩾5 drugs). Polypharmacy was associated with higher age, higher degree of disability, chronic progressive MS disease course and comorbidities. With an average intake of 4.2 drugs per patient, a total of 1033 potential DDIs were identified. Clinically relevant DDIs were significantly more frequent in patients with polypharmacy than in patients without polypharmacy (31.5% versus 5.2%; Fisher’s exact test: p < 0.001). Conclusion: For the first time, a comprehensive range of potential DDIs in women of childbearing age with MS is presented. Polypharmacy is associated with the occurrence of clinically relevant DDIs. This shows the need for effective and regular screening for such interactions in order to prevent avoidable adverse effects.

Associated factors of potential drug-drug interactions and drug–food interactions in patients with multiple sclerosis

“… 33 , 40 We found in a smaller study of 131 women in childbearing age that the prevalence of having at least one pDDI of average danger was significantly higher in Pw/P than in Pw/oP (31.5% versus 5.2%, p < 0.001). 33 There were also significant associations between polypharmacy and higher age, higher degree of disability (EDSS score) and higher number of comorbidities. 33 In our recently published study, we found significantly higher pDDI prevalence rates for MS patients with cardiovascular, neurological, psychiatric and orthopaedic comorbidities.…”

“… 33 There were also significant associations between polypharmacy and higher age, higher degree of disability (EDSS score) and higher number of comorbidities. 33 In our recently published study, we found significantly higher pDDI prevalence rates for MS patients with cardiovascular, neurological, psychiatric and orthopaedic comorbidities. 40 The present study focused on the analysis of pDDIs and their severity by incorporating information from Drugs.com .…”

“…This study thus included more patients than our previous study on MS ( n = 131) and comparable studies on the analysis of pDDIs in other disease contexts (up to n = 481). 33 , 35 – 38 Approval for this study was granted by the ethics committees of the Thuringia Medical Association and the Rostock University Medical Centre (approval numbers A 2014-0089 and A 2019-0048). The study was conducted in accordance with the Declaration of Helsinki.…”

“…Clinically relevant pDDIs were six times more frequent in women with polypharmacy than in women without polypharmacy. 33 …”

Prevalence and Severity of Potential Drug–Drug Interactions in Patients with Multiple Sclerosis with and without Polypharmacy

“…To our knowledge, there were no previous large-scale studies that addressed the issue of pDDIs in patients with MS until today. We previously evaluated pDDIs in MS patients, but this study was focused on a rather small group of women at childbearing age [ 31 ]. Comparisons to other chronic neurological or autoimmune diseases are difficult because the majority of studies dealing with pDDIs and PP were conducted in cohorts of elderly patients or nursing home residents [ 32 , 33 ].…”