The presence of several comorbidities in patients with multiple sclerosis (MS) — migraine, hyperlipidemia, or ≥3 comorbidities — may increase relapse rate over 2 years, according to findings presented at the 7th Joint ECTRIMS-ACTRIMS Meeting in Paris.

“An emerging line of inquiry suggests a potential association between comorbidities and MS relapses, but studies have been limited,” the researchers wrote. “We aimed to evaluate the association between comorbidity and the annualized risk of relapse in MS, in a prospective, multicenter study.”

The researchers recruited 885 participants (678 women; mean age, 48.2 years) with prevalent relapsing-onset MS from 4 Canadian MS clinics to participate in a prospective multicenter, 2-year study involving cross-sectional assessment of comorbidities and relapse.

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Comorbidities were assessed with validated questionnaires and relapses were recorded from medical records at each clinic visit. The association between comorbidities at baseline and relapse rate over the 2-year follow-up period was examined with Poisson regression, adjusting for age, sex, disability, disease duration, and treatment status.

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The researchers found that the most common comorbidities were anxiety (40.2%), depression (21.1%), hypertension (17.7%), migraine (18.1%), and hyperlipidemia (11.9%). The frequency of MS relapse over 2-year follow-up stayed constant, with a rate of 14.9% in year 1 and 13.2% in year 2.

After adjustment, participants who reported 3 or more comorbidities had a higher relapse rate over the 2-year follow-up (adjusted rate ratio [aRR] 1.45; 95% CI, 1.00-2.08) compared with those who reported none. Migraine and hyperlipidemia were also associated with a higher rate of relapse (aRR 1.38; 95% CI, 1.01-1.89 and 1.67; 95% CI, 1.07-2.61, respectively). 

“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,” the researchers concluded. “Future research is needed to examine whether comorbidities warrant a tailored approach to MS management.”

Disclosures: The study authors list several disclosures. Please see the abstract for a full list.


Kowalec K, et al. Comorbidity increases the risk of relapse in multiple sclerosis: a prospective study. Presented at: 7th Joint ECTRIMS-ACTRIMS Meeting. October 25-28, 2017; Paris, France. Abstract P1865.