Ageing and MS; is this an important factor to consider when considering DMTs? #MSBlog #MSResearch
"The study below confirms what we know that age is a predictor of response to DMTs. The older you are the lower the effectiveness of a treatment. Interestingly, Maria Pia-Sormani's group presented a meta-analysis, at the ENS, across all studies showing that age is an important predictor of response to DMTs. The older groups had a lower response rate than younger MSers. What is this telling us? It may tell us that biology of MS changes with time or age-related biological effects have an impact on disease outcomes. We already know that myelination and recovery drops with age. This is in important consideration when we come to thinking about MS; for example, a large component of progressive MS may be premature ageing and at present we have no treatment for this. The message is that if you have active MS you need to get on top of the activity ASAP; the longer you wait, the older you get, and your response rate will drop."
"Ageing and MS; this is a really an important issue. I will need to add it to my tube map."
Epub: Matell et al. Age-dependent effects on the treatment response of natalizumab in MS patients.Mult Scler. 2014 May. pii: 1352458514536085.
BACKGROUND: Natalizumab is approved for treatment of active forms of relapsing-remitting multiple sclerosis (MS) based on a pivotal phase III study comprising MSers aged 18-50 years. The effect of natalizumab has not been specifically studied in older MSers.
OBJECTIVE: We analyzed age-dependent effects on treatment-related outcome measures in 1872 MSers, 189 of whom were aged 50 or more, included in the Swedish post-marketing natalizumab surveillance program.
METHODS: In three MS centers registry data for MSers aged >50 years were validated.
RESULTS: At baseline older MSers had longer disease duration, higher Expanded Disability Status Scale (EDSS) and lower Symbol Digit Modality Test (SDMT) scores than younger MSers. The influence from natalizumab on outcome measures was significantly reduced and 18.7% of MSers >50 years stopped treatment for lack of effect compared to 7.7% in the younger age group. At baseline, the cerebrospinal fluid levels of the chemokine CXCL13 and the leucocyte cell count were negatively correlated with age in a smaller subgroup of MSers.
CONCLUSION: These results were in agreement with previous findings suggesting that inflammation is more pronounced in younger MSers and therefore the beneficial effects of potent anti-inflammatory treatments are subsiding with older ages.