Prescriptions and healthcare use in multiple sclerosis patients within general practices in the Netherlands

BACKGROUND: General practitioners (GPs) have an essential role in Dutch healthcare for people with multiple sclerosis (PwMS), addressing diverse disease symptoms and coordinating supportive care. METHODS: This cross-sectional population-based study cohort was sourced from the 2019 Nivel Primary Care Database in the Netherlands. Non-disease-modifying therapy (DMT) prescriptions and GP healthcare use among PwMS were compared with an age- and sex matched control population, using negative binomial regression adjusting for socio-economic status (SES) and comorbidity burden. Factors associated with polypharmacy (concurrent use of ≥5 medications) and healthcare use in the GP setting in PwMS were evaluated with regression models. RESULTS: Non-DMT prescriptions were prescribed to PwMS (N = 3,013) approximately 1.5 times more frequently than in controls (N = 15,103). Polypharmacy was observed in 28.3% of MS patients (adjusted odds ratio 1.80 compared to controls). Medication classes predominantly contributing to polypharmacy were systemic antibiotics, vitamin supplements, medication for acid related disorders, antihypertensive drugs, and laxatives. PwMS received more GP consultations compared to controls (adjusted incidence rate ratio (aIRR) 1.56 (95% CI 1.49 - 1.63) and were twice as likely to seek care for infectious episodes (aIRR 2.30; 95% CI 2.20 - 2.41). Older age, female sex, higher comorbidity burden, and lower SES were associated with increased polypharmacy and GP healthcare use. Polypharmacy was linked to increased all-cause mortality (aHR 1.69; 95% CI 1.20 - 2.37), albeit similar to controls. CONCLUSION AND DISCUSSION: Polypharmacy of non-DMT prescriptions is prevalent in PwMS and often accompanied by frequent GP visits, highlighting the need for targeted medication review and coordinated primary care.