At the 9th Joint ECTRIMS-ACTRIMS Meeting in October, the nuances of MS in the elderly and the unique challenges facing the treatment of this group of individuals will be explored. By examining recent work in the area, we will identify learnings that could improve the delivery of quality, personalised care for everyone living with MS, including older individuals.
Age, inflammation and MS
A recently published study from Eline Coerver and colleagues [1] examined the relationship between age and magnetic resonance imaging (MRI) measures of inflammatory disease activity during long-term follow-up in a real-world study of individuals with relapse-onset MS. Working from the first clinical event, the investigators used a data modelling approach to fully explore potential links between age and radiological disease activity.
In total, this study enrolled 1063 patients and noted the presence of contrast-enhancing lesions (CELs) in approximately half of the MRI scans performed at baseline. Individuals with CELs were found to be younger than those individuals who did not present with CELs, but with no apparent associations with sex or use of disease-modifying therapies (DMTs). Modelling revealed a lower risk of CELs on baseline MRI for individuals aged 40–50 years compared with those <40 years old.
Individuals in this study were followed for up to 10 years, with the proportion of CELs identified by MRI increasing over this time. Nonetheless, a higher proportion of younger individuals with MS exhibited increased lesions compared with those in older age groups, with almost two-thirds of those <40 years having MRI activity vs approximately one-third of those aged >50 years. The use of DMTs was found to additionally reduce CELs. The investigators also noted that older age at the time of the baseline scan was associated with a lower risk of CELs being recorded at follow-up scans.
CELs may be associated with age across the MS spectrum
The findings from Coerver’s group align with those of Marcus Koch and colleagues [2], who described the frequency of CELs as a function of age in four large, randomised, controlled trial datasets. This study examined data derived from individuals with relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS) and included almost 4,000 patients overall. The investigators grouped individuals with MS into one of five groups, according to age: up to 30 years, 31–40 years, 41–50 years, 51–60 years, and >60 years. The incidence of CELs at baseline in the four randomised trials differed according to disease course, with a higher proportion of individuals with RRMS having CELs compared with individuals with SPMS or PPMS. The investigators observed an almost linear decrease in the proportion of individuals with CELs with increasing age across the five age groups at baseline, and noted that the distribution across the disease course was preserved in all age groups. Decreases in CELs observed following 1 year of treatment within each randomised trial were less pronounced in individuals with RRMS. However, decrease in CELs following 1 year of treatment were additionally influenced by the DMT received, with treatment with glatiramer acetate and interferon-β associated with lesser reductions than either fingolimod or natalizumab. Nonetheless, the almost linear decrease in the incidence of CELs with advancing age was preserved following 1 year of treatment.
Promoting continued advances in research
These are just a few examples of the volume of research carried out by the MS scientific community every year.
Such research continually deepens our understanding of the disease and its treatments helping us to take a step closer to the provision of personalised care with the potential to halt disease progression.
Be part of the charge by attending the 9th Joint ECTRIMS/ACTRIMS Congress in Milan, Italy, which will take place on 11—13 October 2023. Full details can be found here: https://www.ectrims.eu/msmilan2023/
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ECTRIMS Insights articles are produced with the intent of being a neutral source of information sharing and objective analysis for the MS and neuroscience community. Unless otherwise stated, cited information in our articles does equivocate official endorsement from ECTRIMS.
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REFERENCES
[1] Coerver E, et al. Eur J Neurol. 2023:00:1–8. doi: 10.1111/ene.15862.
[2] Koch MW, et al. Neurology. 2021;97(13):e1334–e1342.