The comorbidity profiles and medication issues of patients with multiple system atrophy: a systematic cross-sectional analysis
Authors: Ye Lan , Greten Stephan , Wegner Florian , Doll-Lee Johanna , Krey Lea , Heine Johanne , Gandor Florin , Vogel Annemarie , Berger Luise , Gruber Doreen , Levin Johannes , Katzdobler Sabrina , Peters Oliver , Dashti Eman , Priller Josef , Spruth Eike Jakob , Kühn Andrea A. , Krause Patricia , Spottke Annika , Schneider Anja , Beyle Aline , Kimmich Okka , Donix Markus , Haussmann Robert , Brandt Moritz , Dinter Elisabeth , Wiltfang Jens , Schott Björn H. , Zerr Inga , Bähr Mathias , Buerger Katharina , Janowitz Daniel , Perneczky Robert , Rauchmann Boris-Stephan , Weidinger Endy , Düzel Emrah , Glanz Wenzel , Teipel Stefan , Kilimann Ingo , Wurster Isabel , Brockmann Kathrin , Hoffmann Daniel C. , Klockgether Thomas , Krause Olaf , Heck Johannes ,   PROMESA study group, Maaß Sylvia , Schubert Madeleine , Giese Armin , Oertel Wolfgang H. , Poewe Werner , Trenkwalder Claudia , Wenning Gregor K. , Mansmann Ulrich , Südmeyer Martin , Eggert Karla , Mollenhauer Brit , Lipp Axel , Löhle Matthias , Classen Joseph , Münchau Alexander , Kassubek Jan , Berg Daniela , Egert-Schwender Silvia , Eberhardt Cornelia , Paul Friedemann , Bötzel Kai , Ertl-Wagner Birgit , Huppertz Hans-Jürgen , Ricard Ingrid , André Elisabeth , Blankenstein Christiane , Canelo Monica , Düring Marco , Ebentheuer Jens , Fricke Christopher , Gerbes Alexander , Groiss Stefan , Hartmann Christian , Kirchner Thomas , Kroneberg Daniel , Kunz Martin , Lorenzl Stefan , Moldovan Alexia , Noda Anna , Pape Heidi , Respondek Gesine , Schäffer Eva , Schnitzler Alfons , Schulz-Schaeffer Walter , Schwarz Johannes , Skowronek Cornelia , Storch Alexander , Tadic Vera , Vadász Dávid , Zimmermann Benno , Schneider Martina , Höglinger Günter U. , Klietz Martin 
Published: February 2024

Abstract
Background
Multiple system atrophy (MSA) is a complex and fatal neurodegenerative movement disorder. Understanding the comorbidities and drug therapy is crucial for MSA patients’ safety and management.

Objectives
To investigate the pattern of comorbidities and aspects of drug therapy in MSA patients.

Methods
Cross-sectional data of MSA patients according to Gilman et al. (2008) diagnostic criteria and control patients without neurodegenerative diseases (non-ND) were collected from German, multicenter cohorts. The prevalence of comorbidities according to WHO ICD-10 classification and drugs administered according to WHO ATC system were analyzed. Potential drug-drug interactions were identified using AiDKlinik®.

Results
The analysis included 254 MSA and 363 age- and sex-matched non-ND control patients. MSA patients exhibited a significantly higher burden of comorbidities, in particular diseases of the genitourinary system. Also, more medications were prescribed MSA patients, resulting in a higher prevalence of polypharmacy. Importantly, the risk of potential drug-drug interactions, including severe interactions and contraindicated combinations, was elevated in MSA patients. When comparing MSA-P and MSA-C subtypes, MSA-P patients suffered more frequently from diseases of the genitourinary system and diseases of the musculoskeletal system and connective tissue.

Conclusions
MSA patients face a substantial burden of comorbidities, notably in the genitourinary system. This, coupled with increased polypharmacy and potential drug interactions, highlights the complexity of managing MSA patients. Clinicians should carefully consider these factors when devising treatment strategies for MSA patients.