Trends in central nervous system-active polypharmacy among people with multiple sclerosis

• Published in: Multiple sclerosis Vol. 30; no. 9; pp. 1139 - 1150
• Main Authors: Naizer, Hayden, Wozny, Joseph, Krause, Trudy Millard, Huson, Ethan, Freeman, Leorah
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.08.2024
• Subjects: Adult; Aged; Central Nervous System Agents - therapeutic use; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Multiple Sclerosis - drug therapy; Polypharmacy; Prevalence; United States - epidemiology; Young Adult; United States; Polypharmacy; CNS-active polypharmacy; central nervous system-active polypharmacy; psychotropic polypharmacy; claims analysis; pharmacoepidemiology
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/13524585241251986

Background: People with multiple sclerosis (pwMS) are at risk of concurrently using multiple central nervous system (CNS)-active drugs, yet the prevalence of CNS-active polypharmacy remains unmeasured in pwMS. Objective: The objective is to measure the prevalence of CNS-active polypharmacy in pwMS. Methods: This serial, cross-sectional study measured CNS-active polypharmacy in people with MS in the United States from 2008 to 2021 using insurance claims data. CNS-active polypharmacy was defined as the concurrent prescription of ⩾3 CNS-active drugs for >30 continuous days. CNS-active drugs included antidepressants, antiepileptics, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants. Results: The number of subjects included at each time point ranged from 23,917 subjects in 2008 to 55,797 subjects in 2021. In 2021, subjects with CNS-active polypharmacy were more likely to be 46–65 years of age and have CNS-related comorbidities compared to those without CNS-active polypharmacy. From 2008 to 2021, the age-adjusted prevalence of CNS-active polypharmacy among female subjects increased from 19.8% (95% confidence interval (CI) = 19.1–20.4) to 26.4% (95% CI = 25.9–26.8) versus 15.9% (95% CI = 14.8–17.0) to 18.6% (95% CI = 17.9–19.2) in male subjects. Conclusion: The prevalence of CNS-active polypharmacy has increased among people with MS with a growing disparity by sex.