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. 2025 Sep 3;272(9):607.
doi: 10.1007/s00415-025-13351-2.

The impact of autoimmune comorbidities on multiple sclerosis progression: insights from a longitudinal single-center study

Derya Aslan  1 , Sabrina Bourabia  1 , Bernd Kowall  2 , Agne Straukiene  3 , Konstantin Fritz Jendretzky  4 , Franz Felix Konen  4 , Thomas Skripuletz  4 , Aksel Siva  5 , Mehmet Fatih Yetkin  6 , Tim Hagenacker  1 , Christoph Kleinschnitz  1 , Refik Pul  7 , Jelena Skuljec  1
Affiliations

The impact of autoimmune comorbidities on multiple sclerosis progression: insights from a longitudinal single-center study

Derya Aslan et al. J Neurol. .

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. The presence of other conditions alongside MS imposes a substantial personal and socioeconomic burden. In particular, the impact of comorbid autoimmune diseases (AID) on MS outcomes remains uncertain. In this retrospective longitudinal study, we examined the prevalence of AID in a cohort of patients with different types of MS. For patients with relapsing-remitting MS (RRMS), negative binomial and linear regression models were used to assess adjusted associations between the presence of AID and various other clinical parameters of MS disease. A total of 861 MS patients were included, of whom 148 (17.2%) had one or more comorbid autoimmune diseases (AID). The majority of the patients with MS and AID were women (79.1%). The most prevalent AID was autoimmune thyroiditis (58.1%), followed by psoriasis (16.2%) and type 1 diabetes mellitus (11.5%). Among the 662 RRMS patients, we observed minimal changes in key metrics such as disease-modifying therapies (DMT), relapse rates, steroids dosages, plasma exchanges, or changes in the expanded disability status scale (EDSS) for those with AID. For example, the incident rate of relapses in DMT-naïve patients with AID was nearly identical to that of those without AID (incident rate ratio = 0.92, 95% confidence interval: 0.81 - 1.04). Our findings highlight the notable co-occurrence of AID among patients with MS and suggest that these comorbidities do not affect the progression of RRMS, regardless of DMT use. Reassessing this in large, multicenter, prospective, long-term studies is essential.

Keywords: Autoimmune diseases; Comorbidities; Disease activity; Disease-modifying therapy; Multiple sclerosis.

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Conflict of interest statement

Declarations. Conflicts of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. D. Aslan, S. Bourabia, B. Kowall, and M. F. Yetkin: nothing to declare. A. Straukiene: Biogen Idec, Merck Serono, Novartis, Roche, Sandoz, Sanofi Genzyme and Viatris (speaking and lecture fees, consultation or advisory fees, travel reimbursement). K. F. Jendretzky: Merck, Neuraxpharm, and Novartis (travel reimbursement). F. F. Konen: Argenx, Alexion (consultation or advisory fees), Argenx, Alexion, Merck (speaking and lecture fees), Argenx, Alexion, Merck, Novartis (travel reimbursement). T. Skripuletz: Alnylam Pharmaceuticals, CSL Behring, Merck, Novartis, Siemens (research grant), Alexion, Alnylam Pharmaceuticals, Argenx, Bayer Vital, Biogen, Bristol Myers Squibb, Celgene, Centogene, CSL Behring, Euroimmun, Grifols, Hexal AG, Horizon, Janssen-Cilag, Merck, Novartis, Pfizer, Roche, Sanofi, Siemens, Swedish Orphan Biovitrum, Teva, Viatris (speaking and lecture fees, travel reimbursement), Alexion, Alnylam Pharmaceuticals, Argenx, Biogen, Centogene, CSL Behring, Grifols, Hexal AG, Janssen-Cilag, Merck Serono, Novartis, Roche, Sanofi, Swedish Orphan Biovitrum, Viatris (consultation or advisory fees). A. Siva: F. Hoffmann-La Roche Ltd, Novartis, Sanofi-Genzyme, Merck-Serono, Teva, Biogen Idec/Gen Pharma of Turkey, Alexion, and Abdi Ibrahim Ilaç, Turkey (consultation or advisory fees, speaking and lecture fees and/or travel reimbursement). T. Hagenacker: Alexion, Argenx, Biogen, Roche, UCB, Sanofi (consultation or advisory fees/speaking and lecture fees), Roche and Biogen (funding or grants). C. Kleinschnitz: Neuroscience Fondation, University Münster, Germany and Corona Foundation (board membership), Biontech, Merck, Dermapharm (equity and stock ownership), Alexion, Amgen, Argenx, Astra Zenica, Bayer, Biogen, Bristol Myers-Squibb, C.T.I., Daiichi Sankyo, derCampus, Docspert, Doctorflix, Esai, GE Healthcare, Horizon Therapeutics, Hexal, impulze, Janssen/Johnson-Johnson, Lilly, MedTriX, Merck, Neuroaxpharm, Novartis, Pfizer, Roche, Roland Winter, Sanofi-Aventis, Sandoz, Schmitz, Visuelle Kommunikation, Simon Kucher & Partner, Stada, StreamedUp!, Teva (consulation or advisory fees), Alexion, Amgen, Argenx, Astra Zeneca, Bayer, Biogen, Bristol Myers-Squibb, C.T.I., Daiichi Sankyo, derCampus, Docspert, Doctorflix, Esai, GE Healthcare, Horizon Therapeutics, Hexal, impulse, Janssen/Johnson-Johnson, Lilly, MedTriX, Merck, Neuroaxpharm, Novartis, Pfizer, Roche, Roland Winter, Sanofi-Aventis, Sandoz, Schmitz Visuelle Kommunikation, Simon Kucher & Partner, Stada, StreamedUp!, Teva, Viatris (speaking and lecture fees, travel reimbursement). R. Pul: Alexion, Amgen/Horizon, Bayer Healthcare, Biogen, Bristol-Mayers Squibb/Celgene, Merck, Mylan, Novartis, Roche, Sanofi (consultation or advisory fees, speaking and lecture fees and/or travel reimbursement), Merck and Novartis (funding or grants). J. Skuljec: Alexion, Merck, Roche, and Sanofi (speaking and lecture fees), Novartis and Sanofi (travel reimbursement). Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University Duisburg-Essen (Nr. 22–10594-BO).

Figures

Fig. 1
Fig. 1
The proportion of autoimmune comorbidities in patients with MS. The distribution and types of comorbid autoimmune disease (AID) are presented for all MS patients who have at least one comorbid AID (n = 148). This cohort includes all disease courses: radiologically isolated syndrome, clinically isolated syndrome, relapsing–remitting multiple sclerosis, secondary progressive multiple sclerosis, and primary progressive multiple sclerosis
Fig. 2
Fig. 2
The association between autoimmune comorbidities and clinical parameters in RRMS. a Negative binomial regression models were utilized to predict the usage of disease-modifying therapies (DMT), the number of relapses, and the number of relapses within 12 months after the RRMS onset in untreated patients who have comorbid autoimmune disease (AID). The results are reported as incidence rate ratios (IRR) with 95% confidence intervals (CI). b The outcomes from 1000 bootstrapped linear regression models illustrate the correlation between AID and clinical outcomes in patients with RRMS. Delta EDSS: difference between the last and the first recorded EDSS. Both models (a and b) have been adjusted for the age at the onset of RRMS, sex, and the duration from the initial MS manifestation to the end of the follow-up period
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