Association of clinical epidemiological factors to polypharmacy among patients with multiple sclerosis: real-life data

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Vanessa Marcon de Oliveira
Cinthia Caldas Rios
Vanessa Terezinha Gubert
Cristiane Munaretto Ferreira
Erica Freire de Vasconcelos-Pereira
Mônica Cristina Toffoli-Kadri
Maria Tereza Ferreira Duenhas Monreal


Introduction: Treatment for multiple sclerosis should focus on relapse prevention and treatment, as well as symptom and disease progression control, which require the use of multiple medications. Objective: To evaluate the association of polypharmacy and related clinical, epidemiological factors in multiple sclerosis patient cohorts. Methods: It was conducted a prospective study of multiple sclerosis patients that held a prescription of disease-modifying drugs between January and December 2017. The medications were analyzed and classified as either long-term or as-needed medications for therapeutic objective and prescription status purposes. Results: During 2017, 124 patients were attended, 106 were eligible for the study, and 81 agreed to participate. The average age was 40.95±11.69 years. The disease duration varied between 6 months and 30 years, with a median of 7 years. More than half of the multiple sclerosis patients suffered from comorbidities (54.32%), and 76.54% were categorized as polypharmacy. The comparison of polypharmacy between the groups yielded significant differences for comorbidities and employment status and regarding age between patients with polypharmacy and patients without polypharmacy of long-term medications. Conclusion: The age of the patient and the presence of comorbidities are important factors related to polypharmacy.


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Oliveira, V. M. de, Rios, C. C., Gubert, V. T., Ferreira, C. M., Vasconcelos-Pereira, E. F. de, Toffoli-Kadri, M. C., & Monreal, M. T. F. D. (2021). Association of clinical epidemiological factors to polypharmacy among patients with multiple sclerosis: real-life data. ABCS Health Sciences, 46, e021212.
Original Articles


1. Multiple Sclerosis International Federation (MSIF). Atlas of MS 2013: mapping multiple sclerosis around the world. London: MSIF, 2013.

2. Belbasis L, Bellou L, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-73.

3. Ribeiro TAGJ, Duarte AL, Silva DJ, Borges FE, Costa VM, Papais-Alvarenga RM, et al. Prevalence of multiple sclerosis in Goiânia, Goiás, Brazil. Arq Neuro-Psiquiatr. 2019;77(5):352-6.

4. Pedro L, Pais-Ribeiro JL, Pinheiro JP. A importância de um programa de atividade física em doentes com esclerose múltipla na satisfação com a vida e bem-estar psicológico. Saúde Tecnol. 2013;(Supl.)e49-e51.

5. Halpern R, Agarwal S, Dembek C, Borton L, Lopez-Bresnahan M. Comparison of adherence and persistence among multiple sclerosis patients treated with disease-modifying therapies: a retrospective administrative claims analysis. Patient Prefer Adherence. 2011;20(5):73-84.

6. Frahm N, Hecker M, Zettl UK. Multi-drug use among patients with multiple sclerosis: A cross-sectional study of associations to clinicodemographic factors. Sci Rep. 2019;9:3743.

7. Kochs L, Wegener S, Sühnel A, Voigt K, Zettl UK. The use of complementary and alternative medicine in patients with multiple sclerosis: A longitudinal study. Complement Ther Med. 2014;22(1):166-72.

8. Richardson K, Ananou A, Lafortune L, Brayne C, Matthews FE. Variation over time in the association between polypharmacy and mortality in the older population. Drugs Aging. 2011;28(7):547-60.

9. Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Med. 2015;13:74.

10. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65.

11. Beiske GAG, Holmøy T, Beiske AG, Johannessen SI, Johannessen Landmark C. Antiepileptic and Antidepressive Polypharmacy in Patients with Multiple Sclerosis. Mult Scler Int. 2015;2015:317859.

12. Evans C, Marrie RA, Zhu F, Leung S, Lu X, Kingwell E, et al. Adherence to disease-modifying therapies for multiple sclerosis and subsequent hospitalizations. Pharmacoepidemiol Drug Saf. 2017;26(6):702-11.

13. Jelinek GA, Weiland TJ, Hadgkiss EJ, Marck CH, Pereira N, Medication use in a large international sample of people with multiple sclerosis: associations with quality of life, relapse rate and disability. Neurol Res. 2015;37(8):662-73.

14. Thelen JM, Lynch SG, Bruce AS, Hancock LM, Bruce JM. Polypharmacy in multiple sclerosis: relationship with fatigue, perceived cognition, and objective cognitive performance. J Psychosom Res. 2014;76(5):400-4.

15. Laroni A, Signori A, Maniscalco GT, Lanzillo R, Russo CV, Binello E, et al. Assessing association of comorbidities with treatment choice and persistence in MS: A real-life multicenter study. Neurology. 2017;89(22):2222-9.

16. Marrie RA, Miller A, Sormani MP, Thompson A, Waubant E, Trojano M, et al. Recommendations for observational studies of comorbidity in multiple sclerosis. Neurology. 2016;86(15):1446-53.

17. Frahm N, Hecker M, Zettl UK. Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: A single-center study. PLoS One. 2019;24;14(1):e0211120.

18. Patejdl R, Penner IK, Noack TK, Zettl UK. Multiple sclerosis and fatigue: A review on the contribution of inflammation and immune-mediated neurodegeneration. Autoimmun Rev. 2016;15(3):210-20.

19. Alves CA, Alvarenga MP, Vasconcelos CCF, Batista E, Campanella L, Camargo S, et al. Percalços de um estudo da prevalência de esclerose múltipla no estado do Rio de Janeiro. Rev Bras Neurol Psiquiat. 2013;7(3):103-11.

20. Frahm N, Hecker M, Zettl UK. Polypharmacy in patients with multiple sclerosis: a gender-specific analysis. Biol Sex Differ. 2019;27;10(1):27.

21. World Health Organization (WHO). Global age-friendly cities project. Available from:

22. Marrie R, Reider N, Cohen J, Stuve O, Sorensen PS, Vutter G, et al. A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis. Mult Scler. 2015;21(3):282-93.

23. Kaplan TB, Berkowitz AL, Samuels MA. Cardiovascular Dysfunction in Multiple Sclerosis. Neurologist. 2015;20(6):108-14.

24. Rommer PS, Zettl UK. Managing the side effects of multiple sclerosis therapy: Pharmacotherapy options for patients. Expert Opin Pharmacother. 2018;19(5):483-98.

25. Wingerchuk DM, Carter JL. Multiple sclerosis: Current and emerging disease-modifying therapies and treatment strategies. Mayo Clin Proc. 2014;89(2):225-40.

26. Reich DS, Lucchinetti CF, Calabresi PA. Multiple Sclerosis. N Engl J Med. 2018;378(2): 169-80.

27. Kimball S, Vieth R, Dosch HM, Bar-Or A, Cheung R, Gagne D, et al. Cholecalciferol plus calcium suppresses abnormal PBMC reactivity in patients with multiple sclerosis. J Clin Endocrinol Metab. 2011;96(9):2826-34.

28. Brum DG, Comini-Frota ER, Vasconcelos CCF, Dias-Tosta E. Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology. Arq Neuro-Psiquiatr. 2014;72(2):152-6.

29. James E, Dobson R, Kuhle J, Baker D, Giovannoni G, Ramagopalan SV. The effect of vitamin D-related interventions on multiple sclerosis relapses: a meta-analysis. Mult Scler. 2013;19(12):1571-9.

30. Lentjes MAH. The balance between food and dietary supplements in the general population. Proc Nutr Soc. 2019;78(1):97-109.

31. Schmitz K, Barthelmes J, Stolz L, Beyer S, Diehl O, Tegeder I. “Disease modifying nutricals” for multiple sclerosis. Pharmacol Ther. 2015;148:85-113.

32. Mathur R, Hull SA, Badrick E, Robson J. Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management. Br J Gen Pract. 2011;61(586):262-70.

33. Delcher A, Hily S, Boureau AS, Chapelet G, Berrut G, Decker L. Multimorbidities and overprescription of proton pump inhibitors in older patients. PLoS One. 2015;10(11):e0141779.

34. Wade BJ. Spatial analysis of global prevalence of multiple sclerosis suggests need for an updated prevalence scale. Mult Scler Int. 2014; 2014:124578.

35. Broekmans T, Roelants M, Feys P, Alders G, Gijbels D, Hanssen I, et al. Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis. Mult Scler. 2011;17(4):468-77.