Clinical Characteristics and Long-Term Outcomes of Late-Onset MS
Apr 25, 2024
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Dr. Ellen Iacobaeus discusses late-onset MS in Swedish patients, highlighting differences with adult-onset MS like higher disability levels and less inflammation. She explores challenges in therapy, prescribing patterns, and managing late-onset MS patients, emphasizing the need for tailored treatment and vigilant monitoring.
Late-onset MS patients have faster disability progression compared to adult-onset MS.
Prescription rates of high-efficacy DMT are lower in late-onset MS patients.
Deep dives
Characterizing Late-Onset Multiple Sclerosis
The study aimed to characterize patients with late-onset multiple sclerosis (MS) with symptom onset after 50 years, termed late-onset MS (LOMS). Through a cohort of approximately 9,000 MS patients in Sweden, it was found that 12% were LOMS. LOMS was associated with a more unfavorable disease course compared to adult-onset MS, showing faster disability progression and higher levels of disability at presentation.
Clinical Differences and Progression in LOMS
LOMS patients exhibited risk factors correlating with poor prognosis, such as a higher prevalence of primary progressive MS disease course and increased disability levels at presentation compared to adult-onset MS. Additionally, diagnostic delays and lower prescription rates of disease-modifying therapy were noted in LOMS. LOMS patients experienced faster disability progression, reaching milestones more quickly on the Expanded Disability Status Scale (EDSS).
Therapeutic Considerations for LOMS Patients
Despite a lack of evidence for disease-modifying therapy (DMT) efficacy in older MS patients, a substantial percentage of LOMS patients were prescribed DMT. High-efficacy DMT prescription rates were lower in LOMS than adult-onset MS. Disease progression in LOMS was not impacted by DMT, hinting at the complexity of treatment selection for this population. Future research aims to assess the impact of different DMTs on disability progression in LOMS and to develop tailored treatment guidelines.
Concluding Emphasis on Individualized Care for LOMS
The study highlighted the clinical challenges and nuances of managing late-onset MS patients. Tailored monitoring, treatment, and rehabilitation emphasizing symptom management and comorbidity optimization are crucial. The importance of individualized care and access to non-pharmacological treatments for LOMS, along with screening and management of comorbidities like cardiovascular diseases, was underscored. The call for specific guidelines and research to enhance the care and outcomes of LOMS patients concluded the discussion.
Dr. Justin Abbatemarco talks with Dr. Ellen Iacobaeus about patient characteristics, disease-modifying therapy, and disability progression in Swedish patients with late-onset MS and adult-onset MS over 2 decades.