Monday, 1 June 2015

ClinicSpeak: co-morbidity and MS

Do you have any co-morbidities? Are they being treated? #ClinicSpeak #MSResearch #MSBlog

"Co-morbidity in MS is a really hot topic at the moment. Comorbidity simply means the presence of another medical condition existing simultaneously, but independently of multiple sclerosis. My presentation from the NMSS-ECTRIMS Comorbidity meeting in Toronto earlier this year discusses the definition."

"The study below using population-based administrative records confirms that MS is associated with a reduced survival compared to the general population. In this study the median age of death in MSers was 75.9 years compared to 83.4 years in the matched population. Importantly MS was associated with a 2-fold increased risk of death. Several co-morbidities were associated with increased hazard of death; these included diabetes, ischemic heart disease, depression, anxiety, and chronic lung disease. The most common causes of death in the MS population were diseases of the nervous system and diseases of the circulatory system. Mortality rates due to infectious diseases and diseases of the respiratory system were higher in the MS population. The latter is almost certainly been driven by MS itself and respiratory complications (aspiration pneumonia) as a result of having MS."

"The elephant in the room with regard to this study's findings is the fact that MS starts at a relatively young age (~30 years) and only reduces life expectancy by ~8 years. This means that MSers have to live most of their lives with disability. It is also apparent that MS is associated with co-morbidity that contributes to mortality. The latter observation has also been seen in other autoimmune diseases, for example rheumatoid arthritis where there is good evidence that systemic inflammation is driving peripheral vascular disease. In MS the presence of co-morbidity is associated with a poorer outcome and is one of the factors linked to progressive MS. Any holistic approach  to progressive MS has to tackle comorbidities. For example,  simvastatin may have worked in SPMS via its impact on comorbidities rather than a direct effect on MS. Our recent focus on brain health in MS addresses both the treatment of MS and the co-morbidities associated with MS."  




Epub: Marrie et al. Effect of comorbidity on mortality in multiple sclerosis. Neurology. 2015 May. pii: 10.1212/WNL.0000000000001718.

OBJECTIVE: We aimed to compare survival in the multiple sclerosis (MS) population with a matched cohort from the general population, and to evaluate the association of comorbidity with survival in both populations.

METHODS: Using population-based administrative data, we identified 5,797 persons with MS and 28,807 controls matched on sex, year of birth, and region. We estimated annual mortality rates. Using Cox proportional hazards regression, we evaluated the association between comorbidity status and mortality, stratifying by birth cohort, and adjusting for sex, socioeconomic status, and region. We compared causes of death between populations.

RESULTS: Median survival from birth in the MS population was 75.9 years vs 83.4 years in the matched population. MS was associated with a 2-fold increased risk of death (adjusted hazard ratio 2.40; 95% confidence interval: 2.24-2.58). Several comorbidities were associated with increased hazard of death in both populations, including diabetes, ischemic heart disease, depression, anxiety, and chronic lung disease. The magnitude of the associations of mortality with chronic lung disease, diabetes, hypertension, and ischemic heart disease was lower in the MS population than the matched population. The most common causes of death in the MS population were diseases of the nervous system and diseases of the circulatory system. Mortality rates due to infectious diseases and diseases of the respiratory system were higher in the MS population.

CONCLUSION: In the MS population, survival remained shorter than expected. Within the MS population, comorbidity was associated with increased mortality risk. However, comorbidity did not preferentially increase mortality risk in the MS population as compared with controls.

3 comments:

  1. Do you expect this reduced life expectancy to come closer to that of the non-ms population once studies in the future can reflect the effect of DMTs? Are any studies to date even relevant to the current person with ms who is taking any DMT, particularly a high efficacy one?

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  2. The reason I think lots of patients have problems with comorbitdities is that once you've been dx'd with MS, any time you speak to a doc about anything, it's presumed to be a symptom of MS!

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    1. So true Matt, so sadly true.

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