Late-Onset MS: Disease Course and Safety-Efficacy of DMTS

Maria Chiara Buscarinu,Carmela Romano,Roberta Reniè,Marco Salvetti,Antonio Marrone,Gianmarco Bellucci,Giovanni Ristori,Rachele Bigi,Emanuele Morena

doi:10.3389/fneur.2022.829331

Abstract

Multiple sclerosis (MS), an inflammatory demyelinating and neurodegenerative disease of the central nervous system, usually begins between the ages of 20 and 49 years, though in rare cases it is diagnosed in childhood and adolescence before the age of 18 years, or at the age of 50 years and later. When the onset of the disease occurs at 50 years or older it is conventionally defined as late onset MS (LOMS). Compared to classical MS, the LOMS is characterized by progressive course, a greater delay in diagnosis and a higher prevalence of motor disability. The older the patients, the greater is the risk of comorbidities that can negatively influence the course of the disease and can limit therapeutic strategies. To date, there is no study focused on the efficacy of Disease Modifying Therapies (DMT) in older patients with MS. The only data available are retrievable from subgroup analysis from phase-3 trials of DMT efficacy. In this work, we discuss how the aging process influences the onset, the clinical course and the therapeutic approach in LOMS.

Highlights

Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease of the central nervous system affecting million people worldwide [1]
When the onset of the disease occurs at 50 years or older it is conventionally defined as late onset MS (LOMS)
There is no study focused on the efficacy of Disease Modifying Therapies (DMT) in older patients with MS

Summary

INTRODUCTION

Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease of the central nervous system affecting million people worldwide [1]. The older the patients, the greater is the risk of comorbidities that can negatively influence the course of the disease and can limit therapeutic strategies. There seems to be an increased prevalence of LOMS as well as of very-late-onset MS (VLOMS; conventionally the cases after 60 years). Peculiarities in MRI of LOMS cases are a reduced chance of detecting active lesions and an increased possibility of detecting smoldering plaques [19], which are often termed chronically active They demonstrate lesion-specific rim activity associated with iron-laden macrophages and amplification of the oxidative injury owing to ferritin accumulation, being associated with the onset of progressive disease and with the accelerated accumulation of physical disability [20]. The risk of comorbidities can negatively influence the course of the disease and can limit therapeutic strategies Among those with the highest incidence, there were stroke and cancer.

AGE AND EFFICACY OF DMT

AGE AND SAFETY OF DMT

Findings

FUTURE PERSPECTIVES