Photo Credit: Ralwel
Multiple sclerosis is increasingly prevalent among individuals aged 55 and older, and treatment is impacted by comorbid conditions and polypharmacy.
“Historically, MS has mainly affected younger adults, with first symptoms often presenting between the ages of 20-40,” Óscar Fernández, MD, PhD, and colleagues wrote in Frontiers in Immunology. “However, a growing body of literature underscores an evolving epidemiology with an increasing incidence and prevalence in older individuals. This changing demographic landscape offers an opportunity to understand the disease intricacies within an older population and mandates an in-depth examination of existing and potential management strategies.”
Dr. Fernández and colleagues from several European countries reviewed disease modifying treatments for this subset of patients. He spoke with Physician’s Weekly (PW) about the need for specialized care in older adults with MS.
PW: What prompted this research?
Dr. Fernández: The imperative for conducting this comprehensive review is driven by the shifting epidemiological patterns of MS, which is now increasingly prevalent among individuals aged 55 and older. This demographic evolution introduces unique complexities due to the intricate nexus of aging, comorbidities, immunosenescence, and the pathophysiology of MS. The review endeavors to furnish an updated comprehension of disease management within this cohort, emphasizing the efficacy and safety of disease-modifying treatments (DMTs), the emergence of novel therapeutic modalities, and the critical role of non-pharmacological interventions. It accentuates the necessity for an approach to care that is both personalized and integrative.
What recommendations have been made for managing MS in this group?
In the management of MS among individuals aged 55 and older, the authors advocate for an integrative strategy that critically assesses the efficacy and safety of DMTs, with due consideration for the distinct challenges presented by aging and comorbidities. They highlight the essential role of symptomatic therapy, non-pharmacological interventions, physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy in facilitating a holistic care model. Moreover, the review delineates the importance of advance care planning and the foundational role of MS Care Units in delivering care that is patient-centric.
Does the course of late-onset MS differ from other adult forms?
Indeed, the clinical trajectory of late-onset MS (LOMS) is markedly distinct from that of other adult forms of MS. Characteristically, LOMS is associated with a primary progressive course, leading to a more rapid advancement to disability. Notably, the latency to diagnosis from the onset of symptoms in LOMS is significantly extended, and patients typically exhibit a disease course that is less characterized by inflammation and more by degenerative processes.
How does natural aging influence the features of LOMS?
The aging process exerts a pronounced influence on the differentiation of features in LOMS by exacerbating the decline in immune system functionality, known as immunosenescence, and the amplification of “inflamm-aging.” These phenomena, in conjunction with a diminished capacity for CNS repair and remyelination, render the management of MS in older adults more intricate, necessitating recalibrated therapeutic approaches.
How do comorbid conditions and polypharmacy impact treatment?
The therapeutic landscape of late-onset MS is notably complicated by the presence of comorbid conditions and the prevalence of polypharmacy, elevating the risk for drug-to-drug interactions and AEs, particularly infections. These elements mandate a meticulous evaluation of the advantages and risks associated with DMTs and call for a customized therapeutic approach that duly considers the patient’s overall health status and comorbidities.
What findings are important to emphasize to clinicians?
For clinicians interested in this study, it is paramount to recognize the imperative need for personalized management paradigms for older adults with MS. This encompasses a thorough understanding of the unique challenges this population faces, diligent selection and monitoring of DMTs, and the incorporation of symptomatic and non-pharmacologic treatments to comprehensively address the broad spectrum of symptoms, whose adequate management finally contribute to enhancing the quality of life.
