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Having MS and Other Conditions: Global Group Makes Recommendations for Future Studies of MS Comorbidities

February 18, 2016

Summary
  • Research suggests that having MS along with another medical condition (called a “comorbidity”) may worsen the course of MS. An international group of experts in MS was convened to develop recommendations for addressing comorbidities in future research and clinical trials.
  • The recommendations include conducting studies that determine how common comorbidities (such as depression and high blood pressure) impact the course of MS, and also including people with comorbidities in clinical trials, so that trials better reflect MS in the “real world” setting.
  • These recommendations raise important awareness of comorbidities in MS and provide the MS research community with a road map for identifying solutions that change the lives of people affected by MS. 
  • This project was undertaken by the International Advisory Committee on Clinical Trials in MS, a committee comprised of international leaders in MS research and clinical care that is jointly supported by the National MS Society and ECTRIMS.
  • These recommendations are in two papers by Ruth Ann Marrie, MD, PhD (University of Manitoba, Winnipeg) and others on behalf of participants of the International Workshop on Comorbidity in Multiple Sclerosis, published in Neurology (published early online, February 10 and February 17; no subscription is needed to read these papers).
Background: In scientific terms, having two chronic medical conditions at once is called “comorbidity.” There is growing recognition that comorbidities may complicate the diagnosis of MS and also influence disease progression, as well as an individual’s wellness and quality of life.  In addition, MS and some other disorders may have risk factors in common.  For these reasons, the MS Comorbidities Project sought to characterize the types and frequencies of comorbidities in MS and map out next steps for research strategies to address this gap area. This project was undertaken by the International Advisory Committee on Clinical Trials in MS, a committee comprised of international leaders in MS research and clinical care that is jointly supported by the National MS Society and ECTRIMS.
 
The first phase of this project was a systematic review of existing published studies related to specific medical conditions in people who have MS. (These findings were published in seven papers in the MS Journal; no subscription is needed to read them.) The second phase was the International Workshop on Comorbidity in Multiple Sclerosis chaired by Ruth Ann Marrie, MD, PhD (University of Manitoba, Winnipeg) and Jeffrey Cohen, MD (Cleveland Clinic, who also chairs the International Advisory Committee on Clinical Trials in MS).The workshop gathered an international group of experts in MS, epidemiology, clinical trials, and comorbidity in Toronto, Canada, to develop recommendations for addressing comorbidities in future research and clinical trials.
 
These recommendations are in two papers by Ruth Ann Marrie, MD, PhD (University of Manitoba, Winnipeg) and others on behalf of participants of the International Workshop on Comorbidity in Multiple Sclerosis, published in Neurology (published early online, February 10 and February 17; no subscription is needed to read these papers).
 
Recommendations: Attendees reviewed comprehensive information on what is known about comorbidities of MS. They then discussed recommendations for future research, and for the consideration of comorbidities in clinical trials of experimental MS strategies. Here are some key recommendations:
  • Five comorbidities were targeted for studies that would determine how many people with MS are affected by: depression, anxiety, high blood pressure (hypertension) and high cholesterol (hyperlipidemia). These conditions may affect the course of MS and are potentially treatable.
  • Global studies are key – so much of the current information on comorbidities in MS is from Western Europe and North America. What is happening in the rest of the world?
  • Questions needing answers include: How do comorbidities impact the disease? Do they accelerate nerve cell degeneration? Enhance the immune attack? Studying the possibility of direct biological effects is crucial. Also important is realizing impacts on managing MS – do comorbidities delay the diagnosis of MS, or affect response to treatment? Does treating the comorbidity affect MS as well?
  • Although research indicates that many people with MS have other medical conditions as well, clinical trials often exclude people with these comorbidities. The group suggests relaxing criteria, if there is no specific safety issue, so that trials reflect MS in the “real world” setting. This change is particularly important for trials of treatments for progressive MS, where comorbidities are more common. Trials would have to be larger to achieve the desired statistical power, but recruitment would likely be easier.
  • Comorbidities, and whether they are being treated, should be specifically noted in clinical trials, ideally by reviewing medical records. Also, results – especially adverse events – should be evaluated according to comorbidity status. For example, are all people with hypertension experiencing headaches while taking the medicine?
Next Steps: These recommendations provide the MS research community with a road map for propelling scientific breakthroughs relating to MS and comorbidities. Such breakthroughs can help to identify solutions that change the lives of people affected by MS.
 
Read tips for managing MS when you have other medical conditions.

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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