A single-centre analysis in Germany has found that polypharmacy is common among MS patients, with 56.5% of patients reporting use of 5 or more medications (Frahm et al. Sci Rep 2019;9:3743; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC6403326/pdf/41598_2019_Article_40283.pdf). Most patients were currently taking a disease-modifying therapy (DMT) for MS. Other medications commonly used were gastrointestinal drugs, thrombosis prophylaxis drugs, osteoporosis drugs, antihypertensives and sedatives.

The study population (n=306) comprised patients with CIS/RRMS (62.7%), SPMS (26.1%) and PPMS (11.1%). Average age was 48.7 years. A total of 72.5% were in a relationship and 37.6% were employed. Median duration of MS was 11 years (range 6 weeks to 50 years).

The average number of medications was 5.7/person (range 1-19). The mean number of medications was about 3-fold higher in the polypharmacy versus non-polypharmacy group (8.1 vs. 2.6). The polypharmacy group accounted for 80% of all medications used by the full group. The proportion of polypharmacy patients decreased to 42.2% if PRN medications were excluded and only long-term medications were considered.

In comparing the polypharmacy versus non-polypharmacy groups, the factors associated with polypharmacy included older age (mean 53 years vs. 43 years), a higher level of disability (EDSS 4.5 vs. 2.5), comorbidities (80.9% vs. 42.9%), hospitalization (inpatients: 74.6% vs. 23.3%), educational attainment (university education: 20.2% vs. vs. 30.1%) and employment (employed: 26.0% vs. 52.6%).

When analysed according to EDSS score (< 3 vs. >3), there was no difference in the proportion of patients taking a DMT. The number of symptomatic drugs (2.9 vs. 1.0) and comorbidity drugs (3.5 vs. 2.0) was greater in patients with a higher versus lower EDSS score.

The most common medications used in the polypharmacy group were DMTs (91.9%), GI drugs (68.2%), thrombosis prophylaxis agents (64.7%), osteoporosis drugs (49.1%), sedatives (44.5%), antihypertensives (39.9%), dietary supplements (38.7%), antispasmodics (35.8%), analgesics (31.8%), antiepileptics (27.7%) and antidepressants (26.6%). Use of contraceptives was higher in the non-polypharmacy group (15.0% vs. 8.7%).

Polypharmacy was more common in patients with comorbidities, both in the inpatient group (87.4% vs. 61.0% with no comorbidity) and in the outpatient group (46.2% vs. 11.8% with no comorbidity).

Specific comorbidities in this study were not provided. A meta-analysis reported the most prevalent comorbid conditions in MS patients were depression (23.7%), anxiety (21.9%), hypertension (18.6%), alcohol abuse (14.8%), irritable bowel syndrome (12.2%), hyperlipidemia (10.9%) and chronic lung disease (10.0%) (Marrie et al. Mult Scler 2015;21:263-281).