Klin Farmakol Farm. 2025;39(3):165-170 | DOI: 10.36290/far.2025.060

Treatment of multimorbid patients with multiple sclerosis

Martina Petrášová^{1, 2}, Jan Kočica^{1, 2, 3}

¹ Lékařská fakulta, Masarykova univerzita, Brno

² Neurologická klinika, Fakultní nemocnice Brno

³ Ústav laboratorní medicíny, Fakultní nemocnice Brno

The review summarises practical principles for treating polymorbid patients with multi­ple sclerosis. Comorbidities are common and strongly influence diagnosis, prognosis, and the choice of chronic disease-modifying therapy (DMT); radiographic activity in the setting of vascular comorbidities should therefore be interpreted in the context of additional biomarkers. In highly active disease, early high-efficacy therapy (e. g., anti-CD20 antibodies, cladribine, or natalizumab) has a clear role, always coupled with rigorous pharmacovigilance. Overlapping conditions can be managed safely with parallel, comorbidity-targeted treatment (e. g., anti-CGRP for migraine), whereas some monoclonal antibodies are best avoided in multiple sclerosis (e. g., anti-TNFα). Age and immunosenescence attenuate the expected effect of some DMTs and increase risks; in stable patients, cautious de-escalation may be considered, yet relapses still occur at older ages and therapy should remain individualised. A systematic approach using standardised checklists, active screening and management of comorbidities, and multidisciplinary shared decision-making with the patient, focused on overall quality of life, is recommended.

Keywords: multiple sclerosis, comorbidity, drug therapy, combination, monoclonal antibodies.

Accepted: October 23, 2025; Published: October 30, 2025  Show citation