Most residents of long-term care facilities have multiple chronic conditions, which can make treatment decisions a juggling act for clinicians. But the results of a new study show that multiple chronic diseases do not alter treatment efficacy.
Deciding on the most appropriate treatment for these patients is often challenging, “because clinical trials rarely report whether treatments work as well in people with multiple conditions, and clinical guidelines rarely address the specific needs of these people,” according to researcher Peter Hanlon, GP, of the University of Glasgow in the U.K.
This creates uncertainty about how treatments for single conditions should be applied to these patients, he and his colleagues wrote.
In the new study, the researchers used data from 120 industry-sponsored randomized controlled phase 3 and 4 clinical trials, representing over 128,000 participants. The trials spanned 23 common long-term conditions, including dementia, parkinsonism, diabetes, arthritis, osteoporosis, hypertension, urinary incontinence, glaucoma and psychiatric disorders.
The investigators looked for interactions between treatment efficacy and comorbidities. Overall, they found no evidence of comorbidities changing treatment efficacy across any of the conditions studied. In other words, treatments had similar effects for patients with multiple conditions, they said. Notably, the trials were not designed to assess variation in treatment efficacy by single comorbidity.
The standard assumption is that treatment efficacy is constant across patient subgroups, but this is often criticized, Hanlon and colleagues said in a statement. “Our findings suggest that for modest levels of comorbidities, this assumption is reasonable,” they said.
The results may support the development of new clinical guidelines for these patients, the authors concluded.
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Full findings were published in PLOS Medicine.
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