Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov;268(11):4066-4077.
doi: 10.1007/s00415-020-10107-y. Epub 2020 Jul 27.

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

Larissa Hauer  1 , Julian Perneczky  2 , Johann Sellner  3   4   5
Affiliations

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

Larissa Hauer et al. J Neurol. 2021 Nov.

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system which is associated with numerous comorbidities. These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.

Keywords: Autoimmunity; Comorbidity; Multiple sclerosis; Prevalence; Quality of life; Risk factors; Treatment.

PubMed Disclaimer

Conflict of interest statement

LH and JP have no disclosures. JS has received speaker honoraria from Biogen, GL-Pharma, Merck, Roche, Sanofi and Teva; serves on advisory boards for Alexion, Biogen, Celgene, Merck, Novartis, Roche, Sanofi, Shire and Teva; He received consultancy fees from Immunic and his institution received research support from Biogen, Roche and Merck.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Worldwide distribution of studies on comorbidity in multiple sclerosis
See this image and copyright information in PMC

References

    1. Inojosa H, Schriefer D, Ziemssen T. Clinical outcome measures in multiple sclerosis: a review. Autoimmun Rev. 2020;19(5):102512. doi: 10.1016/j.autrev.2020.102512. - DOI - PubMed
    1. Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247–269. doi: 10.1146/annurev.neuro.30.051606.094313. - DOI - PubMed
    1. Sellner J, Rommer PS. Immunological consequences of "immune reconstitution therapy" in multiple sclerosis: a systematic review. Autoimmun Rev. 2020;19(4):102492. doi: 10.1016/j.autrev.2020.102492. - DOI - PubMed
    1. Waubant E, Lucas R, Mowry E, Graves J, Olsson T, Alfredsson L, Langer-Gould A. Environmental and genetic risk factors for MS: an integrated review. Ann Clin Transl Neurol. 2019;6(9):1905–1922. doi: 10.1002/acn3.50862. - DOI - PMC - PubMed
    1. Feige J, Moser T, Bieler L, Schwenker K, Hauer L, Sellner J. Vitamin D supplementation in multiple sclerosis: a critical analysis of potentials and threats. Nutrients. 2020 doi: 10.3390/nu12030783. - DOI - PMC - PubMed

Publication types