Comorbidity in multiple sclerosis: implications for patient care

Abstract

Most efforts aimed at understanding the notable heterogeneity of outcomes in multiple sclerosis (MS) have focused on disease-specific factors, such as symptoms at initial presentation, initial relapse rate, and age at symptom onset. These factors, however, explain relatively little of the heterogeneity of disease outcomes. Owing to the high prevalence of comorbidity in MS and the potential for its prevention or treatment, comorbidity is of rising interest as a factor that could explain the heterogeneity of outcomes. A rapidly growing body of evidence suggests that comorbidity adversely affects outcomes throughout the disease course in MS, including diagnostic delays from symptom onset, disability at diagnosis and subsequent progression, cognition, mortality, and health-related quality of life. Therefore, clinicians need to incorporate the prevention and management of comorbidity when treating patients with MS, but managing comorbidities in MS successfully may require the adoption of new collaborative models of care.

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Figure 1: Prevalence of comorbidity at MS diagnosis and 5 years earlier10.
Figure 2: Age-specific prevalence of common comorbidities in a prevalent multiple sclerosis cohort from Manitoba in 2010 (Refs 12,16).

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Acknowledgements

This article was supported (in part) by a Don Paty Career Development award from the MS Society of Canada, a Manitoba Research Chair from Research Manitoba, and the Waugh Family Chair in Multiple Sclerosis. R.A.M. receives research funding from Canadian Institutes of Health Research, Research Manitoba, MS Society of Canada, MS Scientific Foundation, National MS Society, Rx & D Health Research Foundation.

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Correspondence to Ruth Ann Marrie.

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R.A.M has conducted clinical trials for Sanofi-Aventis (funds awarded to institution with no personal compensation).

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Marrie, R. Comorbidity in multiple sclerosis: implications for patient care. Nat Rev Neurol 13, 375–382 (2017). https://doi.org/10.1038/nrneurol.2017.33

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