This study examined sex-related differences in the clinical presentation and progression of multiple system atrophy (MSA) through a literature review and retrospective cohort analysis. A PubMed search identified 46 studies addressing sex-related aspects of MSA. Most reported no major differences in survival between sexes, though some suggested women may experience slightly longer survival, potentially due to milder autonomic dysfunction and motor onset patterns. The retrospective Innsbruck cohort included 116 patients (56 women, 60 men) with a median follow-up of 27 months. Female sex was independently associated with higher rates of depression (OR 4.7) and greater use of central nervous system-active medications (OR 4.1). In contrast, male sex was linked to more severe orthostatic hypotension (OR 5.5), supine hypertension (OR 3.0), and increased use and initiation of antihypertensive drugs (OR 8.7 and 12.4, respectively). Overall, both the literature and cohort findings indicate distinct sex-related clinical patterns in MSA, emphasizing the importance of incorporating sex as a variable in clinical assessments, treatment planning, and the design of future MSA trials.
Author(s):
Leys, F., Eschlböck, S., Campese, N. et al
References including authors:
Leys, F., Eschlböck, S., Campese, N. et al. Sex-related differences in the clinical presentation of multiple system atrophy. Clin Auton Res 34, 253–268 (2024).