The following article is part of conference coverage from the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held October 25-28 2021, in Orlando, Florida. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the 2021 CMSC Annual Meeting.


Patients with multiple sclerosis (MS) who have concurrent use of hypnotics and stimulants have worse self-reported quality of life compared with patients who receive either none or 1 of these medication classes, according to study results presented at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held October 25-28, 2021 in Orlando, Florida.

Hypnotics and stimulants are often prescribed concomitantly to patients with MS to address daytime fatigue, sleep disturbance, and quality of life. Yet, large studies on the effects of concomitant use of hypnotics and stimulants on quality of life measures in patients with MS do not exist, according to the current study authors. The objective of the current cross-sectional study was to observe the influence of this dual symptomatic therapy on the quality of life in this patient population.

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The cross-sectional study involved patients from the multicenter MS Partners Advancing Technology and Health Solutions database.

Participants completed the Quality of Life in Neurological Disorders measure during a clinical visit, and data regarding medication use were obtained from electronic medical records. The patients were categorized into groups based on their exposure to different symptomatic therapies. Generalized linear models that adjusted for demographic characteristics, body mass index, MS characteristics, comorbidities, disability, and smoking status were used to analyze differences in quality of life among the groups.

A total of 10,859 patients (mean age 50.8 ± 12.2 years; 74.3% women; 8.97% Black; 22.4% with progressive MS) who had a mean disease duration of 14.3 ± 12.6 years were included. Among the cohort, 414 patients were using both hypnotic and stimulant medications, 2,784 were using stimulants only, 474 were using hypnotics only, and 7,187 were not using any of these treatments.

Patients who were receiving dual therapy had higher odds of self-reporting moderate-to-severe sleep disturbance (odds ratio [OR] 3.4; CI, 2.4-4.8), fatigue (OR 4.0; CI, 2.8-5.7), anxiety (OR 2.3; CI, 1.6-3.4), depression (OR 2.5; CI, 1.7-3.6), and cognitive disturbance (OR 3.4; CI, 2.4-4.8), compared with patients who received neither stimulants nor hypnotics.

“Longitudinal studies on the effect of MS symptomatic therapies on quality of life and symptom management effectiveness and that address the possibility of confounding by indication are warranted to determine their role in the treatment of patients with MS,” the researchers concluded.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Pimentel Maldonado DA, Mukharesh L, Hu C, et al. The effect of hypnotics and stimulants on fatigue, sleep, and quality of life outcomes in a multiple sclerosis cohort. Presented at: CMSC 2021 Annual Meeting; October 25-28, 2021; Orlando, Florida. Abstract SXM02.