The comorbidity profiles and medication issues of patients with multiple system atrophy: a systematic cross-sectional analysis

Lan Ye, Stephan Greten, Florian Wegner, Johanna Doll-Lee, Lea Krey, Johanne Heine, Florin Gandor, Annemarie Vogel, Luise Berger, Doreen Gruber, Johannes Levin, Sabrina Katzdobler, Oliver Peters, Eman Dashti, Josef Priller, Eike Jakob Spruth, Andrea A. Kühn, Patricia Krause, Annika Spottke, Anja SchneiderAline Beyle, Okka Kimmich, Markus Donix, Robert Haussmann, Moritz Brandt, Elisabeth Dinter, Jens Wiltfang, Björn H. Schott, Inga Zerr, Mathias Bähr, Katharina Buerger, Daniel Janowitz, Robert Perneczky, Boris Stephan Rauchmann, Endy Weidinger, Emrah Düzel, Wenzel Glanz, Stefan Teipel, Ingo Kilimann, Isabel Wurster, Kathrin Brockmann, Daniel C. Hoffmann, Thomas Klockgether, Olaf Krause, Johannes Heck, Günter U. Höglinger, Martin Klietz

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2639-2648
Number of pages10
JournalJournal of Neurology
Issue number5
StatePublished - May 2024
Externally publishedYes


  • Comorbidities
  • Drug-drug interactions
  • Genitourinary system diseases
  • Multiple system atrophy
  • Polypharmacy


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