Age is a factor in MS – ECTRIMS 2019

Highlights from the 35th congress of the European Committee for Treatment and Research in MS (ECTRIMS), September 11-13, 2019 – A known risk of MS is increasing levels of disability throughout a person’s life as the disease progresses from the relapsing-remitting to secondary-progressive phase. The reasons for this disability are typically ascribed to myelin damage due to inflammatory flare-ups during the relapsing phase, and the slow creep of nerve cell loss during the neurodegenerative phase. Some people may be able to avoid much of this disability for reasons not entirely understood. For most, the best option for slowing the development of disability is an MS medication.

However, aging itself appears to contribute to the risk of disability. An analysis of the Swiss MS Registry looked at data from over one thousand people across the life span – the twenties, thirties, forties, fifties, sixties, and seventies (von Wyl and colleagues. ECTRIMS 2019; abstract P390). The average age of the group was 49 years. They then compared these age groups with level of impairment as measured with the EDSS scale. (The scale is rated from 0 [no disability] to 10 [death]).

They found that the risk of reaching a point of some disability (from moderate [EDSS 3.5] to needing a wheelchair [EDSS 6.5]) increased 4% per age category. For example, someone in their thirties had a 4% higher risk than someone in their twenties. The same applied to the duration of a person’s MS: for each 10 years of illness there was a 4% higher risk of increasing disability. By comparison, a person’s risk of developing high blood pressure or diabetes was 7-8% per age decade.

Part of the age effect appears to be due to aging of the immune system (called ‘immunosenescence’ or ‘inflammaging’). So efforts are now being made to identify age-related changes to the immune system that may indicate a person has a higher risk of developing disability (Larochelle and colleagues. ECTRIMS 2019; abstract P589).

If the immune system changes with age, does this mean that the medications that target the immune response in MS become less effective over time? One study looked at this question and found that MS treatments were substantially less effective once a person reached their mid-fifties, although many people continued to benefit from therapy (Weideman and colleagues. Front Neurol 2017 ;8:577).

This raises the question of whether it’s worthwhile to continue an MS treatment into old age. A new study at ECTRIMS found that some people over age 60 may be able to stop treatment (Ladeira and colleagues. ECTRIMS 2019; abstract P703). The study group was very specific: people older than 60 years who had been on treatment for many years (8 years on average) and had stable MS for at least two years. They found that people who stopped treatment did no worse than people who stayed on treatment. This doesn’t mean that older people should stop – a position that insurers may be keen to adopt. But it may be an option for some people. But there are two caveats. Most of the study group was taking an injectable medication so their disease likely wasn’t that aggressive. And those who do choose to stop would need to be closely monitored so they can re-start treatment if their disease starts to get worse.

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