Etiology, effects and management of comorbidities in multiple sclerosis: recent advances.

Comorbid conditions commonly affect people with multiple sclerosis (MS). Population-based studies indicate that people with MS have an increased incidence of ischemic heart disease, cerebrovascular disease, peripheral vascular disease, and psychiatric disorders as compared to people without MS. People with MS from underrepresented minority and immigrant groups have higher comorbidity burdens. Comorbidities exert effects throughout the disease course, from symptom onset through diagnosis to the end of life. At the individual level, comorbidity is associated with higher relapse rates, greater physical and cognitive impairments, lower health-related quality of life, and increased mortality. At the level of the health system and society, comorbidity is associated with increased health care utilization, costs and work impairment. A nascent literature suggests that MS affects outcomes from comorbidities. Comorbidity management needs to be integrated into MS care, and this would be facilitated by determining optimal models of care.

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Copyright © 2023 Marrie, Fisk, Fitzgerald, Kowalec, Maxwell, Rotstein, Salter and Tremlett.

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RM receives research funding from: CIHR, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Research Foundation, Crohn’s and Colitis Canada, National Multiple Sclerosis Society, CMSC, the Arthritis Society and the US Department of Defense, and is a co-investigator on studies receiving funding from Biogen Idec and Roche Canada. She holds the Waugh Family Chair in Multiple Sclerosis. KF is a member of the Data and Safety Monitoring Board for A Trial of Bile Acid Supplementation in Patients With Multiple Sclerosis, Comparative Effectiveness Trial of COVID-19 Testing Modalities; VIRTual vs UsuAL in-office care for MS. KK receives research funding from the CMSC, the Department of Defense Congressionally Directed Medical Research Program, through the Multiple Sclerosis Research Program Award No. W81XWH2010566 and NIMH MH123724, National Institutes of Health NIMH. DR has received research support from the MS Society of Canada, Consortium of Multiple Sclerosis Centers CMSC, and Roche Canada. She has received speaker or consultant fees from Alexion, Biogen, EMD Serono, Novartis, Roche, and Sanofi Aventis. AS receives research funding from Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, CMSC and the US Department of Defense and is a member of editorial board for Neurology. She serves as a consultant for Gryphon Bio, LLC. She is a member of the Data and Safety Monitoring Board for Premature Infants Receiving Milking or Delayed Cord Clamping PREMOD2, Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis CAVS-MS, and Ocrelizumab for Preventing Clinical Multiple Sclerosis in Individuals With Radiologically Isolated Disease CELLO. HT has, in the last five years, received research support from the the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the Multiple Sclerosis Scientific Research Foundation and the EDMUS Foundation ‘Fondation EDMUS contre la sclérose en plaques’. JF receives research grant support from the Canadian Institutes of Health Research, the National Multiple Sclerosis Society, the Multiple Sclerosis Society of Canada, Crohn’s and Colitis Canada, Research Nova Scotia; consultation and distribution royalties from MAPI Research Trust. CM is supported by a University Research Chair University of Waterloo and has received research funding from the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the National Multiple Sclerosis Society, Alberta Innovates, CMSC, Ontario Brain Institute Integrated Discovery Program, and the Public Health Agency of Canada.