Comorbidities in newly diagnosed multiple sclerosis patients: A population-based register study in Finland

Background: Comorbidities are common among people with multiple sclerosis (pwMS) and have been suggested to affect the usage of disease-modifying treatments (DMTs). Objectives: We investigated the prevalence and types of comorbidities in newly diagnosed pwMS, as well as the associations between comorbidities and the choice and persistence of the initial DMT. Methods: This retrospective register study used data from the Finnish MS register (85% of national coverage). The inclusion criteria were a diagnosis of relapsing-remitting MS between 2010 and 2022, the first DMT started between 2016 and 2022, and an age of at least 18 years. The exclusion criteria were a diagnosis of secondary progressive MS and initiation of azathioprine or mitoxantrone. Results: The inclusion criteria were met by 1630 pwMS. At least one comorbidity was present in 50.9% of the pwMS. Respiratory comorbidities were associated with the choice of medium-efficacy DMT over high-efficacy DMT (OR = 0.58, CI = 0.36-0.91). Multicomorbidity was associated with lower persistence on all DMTs. Additionally, lower persistence on medium-efficacy DMTs was associated with autoimmune and psychiatric comorbidities and the injectable administration route. Conclusions: Comorbidities are prevalent among newly diagnosed pwMS. Clinicians should consider comorbidities carefully, as they are associated with DMT persistence.