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Tuesday, June 11, 2019

Disease Modifying Therapies in the over 60s

Sophie McConnell

28 May 2019

Dr Jonathan White explains the results of two separate studies which looked at treatment of people over the age of 53.

In November 2017, a large-scale study was published that caused major concern and confusion amongst the MS community (1). From a meta-analysis of more than 28,000 people with MS (pwMS) taking a disease modifying treatment (DMT), researchers concluded that “after age 53…there is no predicted benefit to receiving immunomodulatory DMTs for the average MS patient
Almost immediately, OMS forums and enquiries (and I imagine Neurologists’ offices) filled with people asking questions like
“I’m 55, does that mean I should just stop my medication tomorrow?”
It remains a difficult question to answer when applied to “the real-world” person with MS (pwMS), many of whom had been taking, and remained well on medication for a lengthy period of time. It is extremely important then, that both pwMS and clinicians have as much information as possible to allow for informed decision making.

Another perspective 

A new paper may add a very valuable perspective to this particular problem (2).  Published in “Multiple Sclerosis and Related Disorders”, a team from the United States looked at pwMS over 60, and whether stopping or continuing their medications had any impact on various health-related outcomes.
This was a retrospective, observational study (looking back at results already obtained rather than setting up a new study and testing a particular intervention) including 600 pwMS who were 60 years of age or older and had been on a DMT for 2 years or more.  
The researchers focused on patient reported outcomes (PROs) and timed 25-foot walk (T25FW) test as their key outcome measures.  In simple terms, they asked the people involved a series of standardised questions to gain an understanding of their level of functioning or disability (including mobility, fatigue, cognition, bowel and bladder function, spasticity, hand function, vision and sensation) and other measures such as pain scores and levels of anxiety and depression.  They then objectively measured how long it took the pwMS to walk 25 feet.

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