Five or more medications taken by 70% of MS patients

More than 70% of people with multiple sclerosis (MS) receive outpatient rehabilitation and take at least five medications. These often include vitamin supplements and drugs used to manage symptoms such as muscle stiffness, pain, and mental health issues.

The study in Canada, also found that one quarter of patients take more than 10 medications at the same time.

These results suggest that polypharmacy — defined as the use of five or more medications — is common among people with MS undergoing rehabilitation.

Several clinical and lifestyle factors were linked to a higher prevalence of polypharmacy. These include being retired, using cannabinoids, and having other coexisting conditions.

The team noted that polypharmacy ‘is linked to many adverse outcomes’ among patients.

These findings demonstrate that physical medicine and rehabilitation specialists working with people with MS ‘should be well-informed regarding common side effects, potentially harmful drug-drug interactions, and strategies for reducing polypharmacy,’ the scientists wrote.

People with MS experience a wide range of mental and physical symptoms and often have coexisting conditions such as high blood pressure and chronic lung disease.

As many of these issues require treatment, it’s common for patients to be taking several medications simultaneously.

However, relatively little research has examined medication use in people with MS receiving outpatient physical medicine and rehabilitation.

To learn more, researchers examined medical records from 475 people with MS. They were referred for rehabilitation at a large, specialised MS clinic in Canada between 2021 and 2023. with an average age of 53.1 years. Nearly two-thirds were women.

‘The purpose of this study was to describe patterns of medication use among [people with] MS,’ the researchers wrote.

Polypharmacy was identified in 72% of patients, who were taking an average of 8.9 medications.  In comparison, those without polypharmacy were taking about three medications on average.

Hyperpolypharmacy — defined as taking more than 10 medications — was reported in about one quarter of participants.

Individuals with polypharmacy were significantly older, had been living with MS for longer, and had more coexisting health conditions than those taking fewer medications. These patients also had slightly higher disability levels.

The most frequently used medications were vitamin D, by 74%, baclofen, by 31%, and vitamin B12, by 18%.

Baclofen is a muscle relaxant commonly used to treat spasticity, a symptom of MS which causes muscle stiffness and involuntary muscle spasms.

Looking at drug combinations, the team noted that most combinations involved supplements and other medications used to ease symptoms.

The three most common combinations were supplements and pain medications, supplements and medications for mental health problems, and supplements and spasticity medications.

Further analyses identified several factors associated with a higher prevalence of polypharmacy. Among them were being retired, using cannabinoids, or having at least one physical health or mental health coexisting condition.

‘It is known that many [people with] MS report self-treatment with cannabis to address spasticity, pain, mood and sleep problems, and in one study, 26% used both prescribed medications and cannabis,’ the researchers wrote.

In contrast, full-time or part-time working was associated with a lower prevalence of polypharmacy. The researchers noted that these patients, who are still working, may have fewer symptoms and coexisting conditions, or have higher levels of education, which has been linked to a lower risk of polypharmacy.

Overall, the findings highlight how common polypharmacy is among people with MS receiving rehabilitation care, and that it is ‘associated with a number of sociodemographic, behavioural, and clinical/comorbidity factors,’ the researchers wrote, calling for action by rehab specialists.

Read more about supplement usage in our Diet and Supplements Choices booklet.