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Area of Science:

  • Neurology
  • Immunology
  • Clinical Trials

Background:

  • Comorbidity is linked to worse multiple sclerosis (MS) outcomes, but its effect on disease activity is less understood.
  • Disease activity in MS includes relapses, disability worsening, and magnetic resonance imaging (MRI) lesions.

Purpose of the Study:

  • To investigate the association between comorbidities and disease activity in patients with MS participating in clinical trials.
  • To assess how comorbidity burden impacts measures of MS disease activity relevant to clinical practice and research.

Main Methods:

  • A meta-analysis of individual participant data from 17 phase 3 clinical trials of MS disease-modifying therapies (DMTs) was conducted.
  • Data from 16,794 participants with MS were analyzed over a 2-year follow-up period.
  • Comorbidity burden and specific conditions were assessed at trial enrollment; evidence of disease activity (EDA) was the primary outcome.

Main Results:

  • Higher comorbidity burden was associated with an increased hazard of evidence of disease activity (EDA) in MS patients.
  • Specifically, having three or more comorbidities (adjusted hazard ratio [AHR], 1.14) or two or more cardiometabolic conditions (AHR, 1.21) significantly increased EDA risk.
  • The presence of one psychiatric disorder was also linked to a higher hazard of EDA (AHR, 1.07).

Conclusions:

  • Increased comorbidity burden is associated with greater MS disease activity, including relapses and MRI lesions.
  • Comorbidities may act as mediators of negative prognostic factors in MS.
  • Prevention and management of comorbidities are essential in clinical practice for individuals with MS.