Neurology. 2017 Nov 28;89(22):2222-2229. doi: 10.1212/WNL.0000000000004686. Epub 2017 Nov 1.
To assess whether the presence of concomitant diseases at multiple sclerosis (MS) diagnosis is associated with the choice and the treatment persistence in an Italian MS cohort.
We included newly diagnosed patients (2010-2016) followed in 20 MS centers and collected demographic and clinical data. We evaluated baseline factors related to the presence of comorbidities and the association between comorbidities and the clinical course of MS and the time to the first treatment switch.
The study cohort included 2,076 patients. Data on comorbidities were available for 1,877/2,076 patients (90.4%). A total of 449/1,877 (23.9%) patients had at least 1 comorbidity at MS diagnosis. Age at diagnosis (odds ratio 1.05, 95% confidence interval [CI] 1.04-1.06; < 0.001) was the only baseline factor independently related to the presence of comorbidities. Comorbidities were not significantly associated with the choice of the first disease-modifying treatment, but were significantly associated with higher risk to switch from the first treatment due to intolerance (hazard ratio 1.42, CI 1.07-1.87; = 0.014). Association of comorbidities with risk of switching for intolerance was significantly heterogeneous among treatments (interferon β, glatiramer acetate, natalizumab, or fingolimod; interaction test, = 0.04).
Comorbidities at diagnosis should be taken into account at the first treatment choice because they are associated with lower persistence on treatment.
评估多发性硬化症（MS）诊断时并存疾病的存在是否与意大利 MS 队列中的治疗选择和治疗持久性相关。
我们纳入了 2010 年至 2016 年间在 20 个 MS 中心接受随访的新诊断患者，并收集了人口统计学和临床数据。我们评估了与并存疾病存在相关的基线因素，以及并存疾病与 MS 临床病程以及首次治疗转换时间之间的关联。
研究队列包括 2076 例患者。1877/2076 例（90.4%）患者的并存疾病数据可用。共有 449/1877 例（23.9%）患者在 MS 诊断时至少存在 1 种并存疾病。诊断时的年龄（优势比 1.05，95%置信区间[CI] 1.04-1.06；<0.001）是与并存疾病存在相关的唯一基线因素。并存疾病与首次疾病修饰治疗的选择无显著相关性，但与因不耐受而从首次治疗转换的风险显著相关（危险比 1.42，CI 1.07-1.87；=0.014）。并存疾病与不耐受转换风险的相关性在治疗之间存在显著的异质性（干扰素β、聚乙二醇干扰素、那他珠单抗或芬戈莫德；交互检验，=0.04）。
诊断时并存疾病应在首次治疗选择时考虑，因为它们与治疗的持久性降低相关。
