Abstract
This review presents the latest evidence available regarding treating patients with MS over age 50. This includes what is known about disease-modifying therapies, symptomatic interventions, and comorbid conditions that influence disease management in older patients. There is limited clinical trial data for patients over age 50. Recent meta-analyses of clinical trials of immunomodulatory therapies indicate there is minimal efficacy after age 50 on disability progression. Additionally, immunosenescent changes increase risks of adverse effects in older adults. Advances in understanding disease progression offer new treatment targets. Fortunately, emerging therapies on progression and repair have included older patients and will hopefully lead to neurodegenerative therapies and allow tailored treatments based on age. While data is limited to support the use of immunomodulatory therapies in older patients, treatment decisions should be made on an individual basis based on disease activity, patient-specific factors, and patient preference. It is also important to focus on symptoms and comorbidities that affect quality of life.
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