Grant: Travel Awards - Institute Community Support

Amyotrophic lateral sclerosis (ALS) is a rare and progressive disease that causes muscle weakness, paralysis, and early death. Many people living with ALS take medications called anticholinergics to help control issues like drooling, bladder problems, and difficulty sleeping. These medications work by blocking a natural chemical in the body called acetylcholine, which helps nerves communicate with muscles. In other diseases, higher anticholinergic exposure, whether from a single strong medication or from several drugs used together, has been linked to confusion, memory problems, falls, hospital stays, and even a higher risk of death. Despite their common use in ALS, no studies have examined whether these medications could accelerate disease progression or shorten survival. This is an important question because anticholinergic medications can disrupt nerve-muscle communication and increase inflammation, processes that also play a role in ALS. Research outside of ALS also suggests that anticholinergic exposure can impair lung function, reduce muscle strength, and is associated with poorer survival. Yet, current ALS treatment guidelines still recommend several of these drugs as first-line options for managing drooling and urinary urgency, without addressing their combined or long-term effects. My research will be the first to study whether anticholinergic medication use in ALS is associated with faster disease progression and higher mortality. Using large Canadian health databases that record prescription, hospital, and outcome data, I will apply a study design that mirrors a clinical trial to produce accurate and unbiased results. These findings could improve care for people living with ALS by encouraging safer use of medications and updating treatment guidelines. Results will be presented at the International Society for Pharmacoepidemiology (ISPE) Annual Meeting in Milan, Italy, from August 29 to September 2, 2026.