Polypharmacy Plays a Role in Patients With Relapsing-Remitting Multiple Sclerosis

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Polypharmacy (patients taking ≥5 medications) is not uncommon in patients with relapsing-remitting multiple sclerosis and it is associated with higher levels of disability and the presence of comorbidities.

Patients with relapsing-remitting multiple sclerosis (RRMS) can have a high burden of polypharmacy, which arises from the chronic and heterogenous nature of the disease, according to a new study PLOS ONE.

Researchers from the University of Rostock in Germany examined the frequency of polypharmacy among patients with RRMS, as well as factors that might be associated with the use of ≥5 medications.

An increasing frequency of polypharmacy has been viewed among the general population, but few studies have examined the frequency of polypharmacy among patients with MS, the authors explained. In MS, a variety of symptoms occur, such as fatigue, coordination disturbances, pain, and sensory disturbances, and are treated to improve patients’ quality of life.


“In view of this complexity of treatment scenarios, the factor of polypharmacy needs to be taken into account,” the authors wrote.

Data on 145 patients with RRMS was gathered between March 2017 and April 2018 through anamnesis and patient records, clinical examination, and a structured patient interview. The authors also evaluated associations with sociodemographic and clinical-neurological data, using Kurtzke’s Expanded Disability Status Scale (EDSS). Sociodemographic data included age, gender, education level, employment, and place of residence.

Nearly one-third (30.3%) of patients were taking ≥5 medication, and among the total group of participants the average number of medications being taken was 3.6. Patients with polypharmacy (PwP) were older with an average age of 45.9 years compared with an average age of 41.7 years for patients without polypharmacy (Pw/oP). In addition, Pw/oP were more likely to be employed (59.4%) compared with PwP (34.1%). There were more retirees in the PwP group than in the Pw/oP group (59.1% vs 30.7%).

The median EDSS score was lower for Pw/oP than PwP (2.0 vs 3.0). A higher risk of polypharmacy more likely among patients with a higher EDSS score and the presence of comorbidities.

The most common medication among both PwP and Pw/oP was disease-modifying drugs (95.9%), followed by dietary supplements (33.8%), analgesics (29.0%), osteoporosis drugs (22.8%), and contraceptives (22.1%). More than half of PwP took dietary supplements (54.5%) and analgesics (50.0%) compared with fewer than one-fourth Pw/oP (24.8% and 19.8%, respectively).

“For avoiding drug interactions and their clinical consequences, a well thought-out medication management that is based on the optimization of drug use is vital,” the authors suggested. “A possibility for an adequate adaption or control lies in the analysis of the prescribed medications by the physician in order to check whether all medications are indeed essential and up-to-date for the respective patient.”


Frahm N, Hecker M, Zettl UK. Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: a single-center study. PLoS One. 2019;14(1):e0211120. doi: 10.1371/journal.pone.0211120.