Comorbidity increases the risk of relapse in multiple sclerosis: a prospective study
ECTRIMS Online Library. Kowalec K. 10/27/17; 199885; P1865
Kaarina Kowalec
Kaarina Kowalec
Contributions
Abstract

Abstract: P1865

Type: Poster

Abstract Category: Late breaking news

Background and aim: Comorbid conditions, such as diabetes and hypertension, are frequent in multiple sclerosis (MS) and are associated with increased hospitalizations, greater disability progression, mortality risk, and contrast-enhancing lesions on brain MRI. It has been proposed that comorbidity may explain part of the heterogeneity in outcomes such as disability progression between individuals with MS. An emerging line of inquiry suggests a potential association between comorbidities and MS relapses but studies have been limited. We aimed to evaluate the association between comorbidity and the annualized risk of relapse in MS, in a prospective, multicenter study.
Methods: We recruited individuals with prevalent relapsing-onset MS from four Canadian MS Clinics to participate in a two-year prospective multi-center cohort study involving cross-sectional assessment of comorbidities and relapses. Comorbidities were recorded using validated questionnaires, and relapses were captured from medical records at each clinic visit. The association between comorbidities at baseline and relapse rate over the subsequent two-year follow-up period was examined using Poisson regression, adjusting for age, sex, disability, disease duration, and treatment status.
Results: Of 885 participants, 678 (76.6%) were women, with a mean (SD) age of 48.2 (11.1) years at baseline. The most prevalent comorbidities were anxiety (40.2%), depression (21.1%), hypertension (17.7%), migraine (18.1%) and hyperlipidemia (11.9%). The frequency of participants experiencing relapses remained constant at 14.9% and 13.2% in years one and two post-baseline. After adjustment, participants reporting ≥3 baseline comorbidities (relative to none) had a higher relapse rate over the subsequent two years (adjusted rate ratio [aRR]: 1.45, 95%CI: 1.00-2.08). Specifically, migraine and hyperlipidemia were also associated with increased relapse rate (aRR: 1.38; 95%CI: 1.01-1.89 and 1.67; 95%CI: 1.07-2.61, respectively).
Conclusions: Individuals with MS and migraine, hyperlipidemia or ≥3 comorbidities had an increased relapse rate over two years. These findings have potential implications for understanding the pathophysiology of MS relapses, and may suggest closer monitoring of individuals with specific or multiple comorbidities is needed. Future research is needed to examine whether comorbidities warrant a tailored approach to MS management.
Disclosure:
Drs. Kowalec, Evans, and Patten report no disclosures.
Dr. McKay is funded by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.
Dr. Fisk receives research funding from the CIHR, MS Society of Canada, National MS Society, Dalhousie Medical Research Foundation, consultation and distribution royalties from MAPI Research Trust, and has received speaker honoraria and travel expenses from EMD Serono (2014).
Dr. Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. She currently receives research support from the National MS Society, the CIHR, the MS Society of Canada and the MS Scientific Research Foundation. In addition, in the last five years she has received research support from the MS Society of Canada (Don Paty Career Development Award); the Michael Smith Foundation for Health Research (Scholar Award) and the UK MS Trust; speaker honoraria and/or travel expenses to attend conferences from the Consortium of MS Centres (2013), the National MS Society (2012, 2014, 2016), ECTRIMS (2012, 2013, 2014, 2015, 2016), the Chesapeake Health Education Program, US Veterans Affairs (2012), Novartis Canada (2012), Biogen Idec (2014), American Academy of Neurology (2013, 2014, 2015, 2016). All speaker honoraria are either declined or donated to an MS charity or to an unrestricted grant for use by her research group.
Dr. Marrie has conducted clinical trials for Sanofi-Aventis and receives research funding from CIHR, the National MS Society, the MS Society of Canada, the MS Scientific Research Foundation, Research Manitoba, the Consortium of MS Centers, Crohn's and Colitis Canada and the Waugh Family Chair in Multiple Sclerosis. She serves on the Editorial Board for Neurology.
Study funded by the Canadian Institutes of Health Research (CIHR) (CBG 101829).

Abstract: P1865

Type: Poster

Abstract Category: Late breaking news

Background and aim: Comorbid conditions, such as diabetes and hypertension, are frequent in multiple sclerosis (MS) and are associated with increased hospitalizations, greater disability progression, mortality risk, and contrast-enhancing lesions on brain MRI. It has been proposed that comorbidity may explain part of the heterogeneity in outcomes such as disability progression between individuals with MS. An emerging line of inquiry suggests a potential association between comorbidities and MS relapses but studies have been limited. We aimed to evaluate the association between comorbidity and the annualized risk of relapse in MS, in a prospective, multicenter study.
Methods: We recruited individuals with prevalent relapsing-onset MS from four Canadian MS Clinics to participate in a two-year prospective multi-center cohort study involving cross-sectional assessment of comorbidities and relapses. Comorbidities were recorded using validated questionnaires, and relapses were captured from medical records at each clinic visit. The association between comorbidities at baseline and relapse rate over the subsequent two-year follow-up period was examined using Poisson regression, adjusting for age, sex, disability, disease duration, and treatment status.
Results: Of 885 participants, 678 (76.6%) were women, with a mean (SD) age of 48.2 (11.1) years at baseline. The most prevalent comorbidities were anxiety (40.2%), depression (21.1%), hypertension (17.7%), migraine (18.1%) and hyperlipidemia (11.9%). The frequency of participants experiencing relapses remained constant at 14.9% and 13.2% in years one and two post-baseline. After adjustment, participants reporting ≥3 baseline comorbidities (relative to none) had a higher relapse rate over the subsequent two years (adjusted rate ratio [aRR]: 1.45, 95%CI: 1.00-2.08). Specifically, migraine and hyperlipidemia were also associated with increased relapse rate (aRR: 1.38; 95%CI: 1.01-1.89 and 1.67; 95%CI: 1.07-2.61, respectively).
Conclusions: Individuals with MS and migraine, hyperlipidemia or ≥3 comorbidities had an increased relapse rate over two years. These findings have potential implications for understanding the pathophysiology of MS relapses, and may suggest closer monitoring of individuals with specific or multiple comorbidities is needed. Future research is needed to examine whether comorbidities warrant a tailored approach to MS management.
Disclosure:
Drs. Kowalec, Evans, and Patten report no disclosures.
Dr. McKay is funded by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.
Dr. Fisk receives research funding from the CIHR, MS Society of Canada, National MS Society, Dalhousie Medical Research Foundation, consultation and distribution royalties from MAPI Research Trust, and has received speaker honoraria and travel expenses from EMD Serono (2014).
Dr. Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. She currently receives research support from the National MS Society, the CIHR, the MS Society of Canada and the MS Scientific Research Foundation. In addition, in the last five years she has received research support from the MS Society of Canada (Don Paty Career Development Award); the Michael Smith Foundation for Health Research (Scholar Award) and the UK MS Trust; speaker honoraria and/or travel expenses to attend conferences from the Consortium of MS Centres (2013), the National MS Society (2012, 2014, 2016), ECTRIMS (2012, 2013, 2014, 2015, 2016), the Chesapeake Health Education Program, US Veterans Affairs (2012), Novartis Canada (2012), Biogen Idec (2014), American Academy of Neurology (2013, 2014, 2015, 2016). All speaker honoraria are either declined or donated to an MS charity or to an unrestricted grant for use by her research group.
Dr. Marrie has conducted clinical trials for Sanofi-Aventis and receives research funding from CIHR, the National MS Society, the MS Society of Canada, the MS Scientific Research Foundation, Research Manitoba, the Consortium of MS Centers, Crohn's and Colitis Canada and the Waugh Family Chair in Multiple Sclerosis. She serves on the Editorial Board for Neurology.
Study funded by the Canadian Institutes of Health Research (CIHR) (CBG 101829).

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