NEW ORLEANS – Comorbidities such as hyperlipidemia, hypertension, gastrointestinal disorders, and depression are significantly more common among patients with multiple sclerosis, compared with patients who do not have the condition.
The findings, based on a large analysis of national claims data that was presented at the annual meeting of the Consortium of Multiple Sclerosis Centers, may better inform physicians and patients about potential comorbidities in patients with MS, lead study author Kiren Kresa-Reahl, MD, said in an interview. “The challenge is, what is the underlying problem?” she asked. “Is it the chicken or the egg? It may be that MS lesions on the brain and microvascular disease look similar, so it’s hard to know. There are also conditions that are caused by MS, such as depression. Is it caused by MS the disease or is it a comorbidity with MS? That’s hard to know.”
Dr. Kiren Kresa-Reahl
In an effort to compare the prevalence of comorbidities in patients with and without MS, Dr. Kresa-Reahl and her associates retrospectively evaluated IMS Health Real World Data Adjudicated Claims-U.S. data between Jan. 1, 2011, and Sept. 30, 2015. The database includes about 150 million patients with a medical benefit and a subset of 95 million patients with both medical and pharmacy benefits. MS patients were required to have at least two claims with an ICD-9 diagnosis of MS 30 days apart and to be between the ages of 18 and 65.
The researchers drew from a systematic review of the 10 most common comorbidities in MS (Mult Scler. 2015;21:263-81) and then matched 69,550 MS patients to a pool of 3,129,573 patients without MS by age group, gender, geographic region, and index quarter year. This left 66,616 patients in each cohort. Their mean age was 46 years, 76% were female, and the majority had commercial health insurance (97% of MS patients and 95% of those without the condition).
Of the 10 common comorbidities, eight occurred significantly more frequently among MS patients, compared with those without the condition (P less than .0001 for all). These included hyperlipidemia (27.76% vs. 24.57%, respectively), hypertension (26.91% vs. 23.50%), GI disorders (18.02% vs. 13.84%), depression (16.12% vs. 9.62%), thyroid disease (15.77% vs. 12.05%), anxiety (12.27% vs. 9.32%), and chronic obstructive pulmonary disease (10.39% vs. 9.52%).
Dr. Kresa-Reahl, a neurologist at the Providence Multiple Sclerosis Center in Portland, Ore., and her associates also found that patients with MS had a significantly lower prevalence of alcohol abuse, AIDS, mild liver disease, and moderate liver disease than did patients without MS (P less than .05 for all). There were no differences between groups in the prevalence of diabetes without complications or in metastatic tumor (P greater than .05).
She acknowledged certain limitations of the study, including the potential for missing information and the inability of the researchers to determine which form of MS the patients had. “It might be that if we looked at just Medicare and Medicaid patients, these diagnoses would be a little bit different,” Dr. Kresa-Reahl added. “Maybe they would have more disability or more depression or more limited mobility. It’s hard to know, but this is a snapshot of people who have commercial insurance, so maybe they would be more likely to be employed.”
The study was sponsored by EMD Serono. Dr. Kresa-Reahl disclosed that she has received consulting fees from Biogen and EMD Serono; speakers fees and honoraria from Biogen, EMD Serono, Genzyme, Mallinckrodt, Novartis, and Teva; and grant/research support from Biogen, Genentech, Genzyme, Mallinckrodt, and Novartis.