1Christos Bakirtzis, 1Marina – Kleopatra Boziki, 1Eleni Grigoriadou, 1Evangelia Kesidou, 1Ioannis Nikolaidis, 1Styliani-Aggeliki Sintila, 2Theodoros Moysiadis, 2Dimitra Tsakona, 3Georgios Papazisis, 1Nikolaos Grigoriadis
1Multiple Sclerosis Center, B’ Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece; 3Department of Clinical Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Besides Disease Modifying Therapies (DMTs), various pharmacologic agents (PAs) are frequently prescribed to people with multiple sclerosis (PwMS) for the treatment of MS related symptoms and other comorbid conditions. Pharmacoepidemiological data regarding the prescribed PAs in PwMS are scarce. With this study we aim to investigate the types and frequencies of the prescribed PAs to PwMS in Greece, using records of the nationwide digital prescription database.
Design and Method(s):
We have previously analyzed data from the nationwide digital prescription database, dating from June 1, 2017, to May 31, 2019, and identified 21,218 (13,994 or 65.8% females) MS cases, using the ICD-10 code for MS (G35). In this study, we further explored all prescribed PAs to the identified population during this 2-year period. Criterion for the PA identification was at least 3 months of continuous prescription of the agent. Since comorbid disease coding misclassifications may lead to inaccurate results, this analysis was performed on the basis of the active substances. The identified PAs were then classified into various categories according to the WHO Anatomical Therapeutic Chemical (ATC) classification system. Identified cases were further divided into 4 age groups (under 18, 18-39, 40-60, over 60) and we calculated the number and percentage of PwMS under treatment with each PA category.
Overall, 15,520 (73.1 %) PwMS were treated at least once with a DMT during this study period. The most frequently prescribed drugs for symptomatic treatment were anti-spasticity agents (n:3721, 17.5%), followed by fampridine (n:3092, 14.5%). Regarding treatment of comorbid conditions, antihypertensives (n:4483, 21.1%) and drugs for affective disorders such as antidepressants (n:7660, 36.1%) and anxiolytics (n:3444, 16.2%) were the most commonly prescribed PAs. Antiepileptics (n: 2936, 13.8%), anti-ulcers (n: 2919, 13.7%) and urinary antispasmodics (n: 2308, 10.8%) were also frequently prescribed as symptomatic treatment or for comorbid conditions. (table). As expected, with the exception of DMTs, the prescriptions of PAs in the <18 age group were uncommon, while the percentage of PwMS under treatment with all other PA categories, was increasing with age. Regarding prescriptions for comorbid conditions, 10,481 (49.4%) PwMS were not prescribed any PA, 4,455 (21%) were prescribed PAs of one category, 2,949 (13.9%) were prescribed PAs of two categories and 3,314 (15,6%) were prescribed PAs of 3 or more categories (figure).
The present national level study highlights the frequent concomitant use of various PAs in PwMS. Comorbid conditions are commonly observed, especially in advancing age. Although PAs prescribed for the treatment of other medical conditions and for MS related symptoms, are expected to positively affect the quality of life of PwMS, future studies should further investigate their potential drug interactions with DMTs. In addition, the impact of polypharmacy to the disease course should also be further studied.