The comorbidity profiles and medication issues of patients with multiple system atrophy: a systematic cross-sectional analysis

Abstract

Background: Multiple system atrophy (MSA) is a complex and fatal neurodegenerative movement disorder. Understanding the comorbidities and drug therapy is crucial for MSA patients' safety and management.

Objectives: To investigate the pattern of comorbidities and aspects of drug therapy in MSA patients.

Methods: Cross-sectional data of MSA patients according to Gilman et al. (2008) diagnostic criteria and control patients without neurodegenerative diseases (non-ND) were collected from German, multicenter cohorts. The prevalence of comorbidities according to WHO ICD-10 classification and drugs administered according to WHO ATC system were analyzed. Potential drug-drug interactions were identified using AiDKlinik®.

Results: The analysis included 254 MSA and 363 age- and sex-matched non-ND control patients. MSA patients exhibited a significantly higher burden of comorbidities, in particular diseases of the genitourinary system. Also, more medications were prescribed MSA patients, resulting in a higher prevalence of polypharmacy. Importantly, the risk of potential drug-drug interactions, including severe interactions and contraindicated combinations, was elevated in MSA patients. When comparing MSA-P and MSA-C subtypes, MSA-P patients suffered more frequently from diseases of the genitourinary system and diseases of the musculoskeletal system and connective tissue.

Conclusions: MSA patients face a substantial burden of comorbidities, notably in the genitourinary system. This, coupled with increased polypharmacy and potential drug interactions, highlights the complexity of managing MSA patients. Clinicians should carefully consider these factors when devising treatment strategies for MSA patients.

Keywords: Comorbidities; Drug-drug interactions; Genitourinary system diseases; Multiple system atrophy; Polypharmacy.

Fig. 1

Prevalence of comorbidities according to ICD-10 classification. *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001, chi-squared test. The figure illustrates the prevalence of the comorbidities on the first level (A, C) and the most common comorbidities for the MSA and the control group, respectively, on the second level (B, D) of the ICD-10 classification system. The comparison between the prevalence in MSA and control patients (A, B) as well as in MSA-C and MSA-P (C, D) is pointed out. ICD international classification of diseases, MSA multiple system atrophy, MSA-P multiple system atrophy with predominant parkinsonism, MSA-C multiple system atrophy with cerebellar ataxia, non-ND without neurodegenerative diseases

Fig. 2

Prevalence of administered drugs according to ATC classification and potential drug-drug interactions. *p < 0.05, **p < 0.01, ***p < 0.001,****p < 0.0001, chi-squared test. The figure shows the prevalence of the most common drugs for MSA-P or for MSA-C administered on the third level of WHO ATC system (A, C) and the prevalence of pDDIs according to their severity (B, D). The comparisons between the prevalence in MSA and control patients (A, B) as well as in MSA-P and MSA-C (C, D) are indicated. ATC anatomical therapeutic chemical, MSA multiple system atrophy, MSA-P multiple system atrophy with predominant parkinsonism, MSA-C multiple system atrophy with cerebellar ataxia, non-ND without neurodegenerative diseases