MS is Different in Older Adults

The treatment of older adults with MS can be challenging with the lack of evidence-based guidelines specific to this growing cohort of patients. For years, older people have been underrepresented in pharmaceutical clinical trials. The average age of participants in early pivotal trials for IFN𝛽 drugs was 35, while those over the age of 50 or 55 were excluded. More recent studies have increased upper age limits to 60 or 65 years old. Also, older people tend to have more comorbidities, a common reason for exclusion from many clinical trials.

Authors of the Canadian study emphasize that further studies are needed to develop evidence-based guidelines for this special population. Information regarding the impact of DMTs in older MS patients is needed for a number of reasons:

• Older adults with MS are typically treated using therapeutic guidelines originally established for younger adults, without direct evidence to support this practice.
• Aging affects the pharmacodynamics and pharmacokinetics of drugs, as well as the immune system, thus immunomodulatory therapies might have a different effect in older MS patients.
• Follow-up time in clinical trials is typically 2-3 years, too short to capture the longer term progression profile of patients. 
• Clinical trial settings differ from real-world settings, especially in respect to patient characteristics, such as comorbidities and the motivation or ability to adhere to medications.
• As the prevalence of older people living with MS continues to increase with an aging population, there is an important need to better understand the characteristics of older patients including their potential response to drug treatments for MS.

While researchers gather evidence that shows particular therapies are less effective in older MS patients, it is important to explore more effective options.

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Multiple Sclerosis in Older Adults