Here we present viewpoints of experts from around the world on aspects relevant for the care of middle-life or older patients with MS, or other clinically vulnerable patients with the disease.
Prof. Anthony Reder, USA
With age, the immune systems changes - what does this mean for our patients with MS?
With age, the immune systems changes; our ability to face immunological challenges decreases, we become more prone to infections and we are less able to generate a good immune response to vaccination. What triggers these changes, why don’t all people age equally and what happens in MS?
Anthony Reder, professor of Neurology, MS clinician and researcher at the University of Chicago for many years provides insights into the age-related changes of the immune system, particularly in people with MS.
So, what does this mean for our patients with MS when they get older? “This is complicated… every 60 year-old is not the same. Some people are in great shape - others look old or are old, immunologically. Biological ageing means that MS therapies have to be tailored individually.”
Listen to Professor Reder as he explains how beta interferons have antiviral properties and may enhance antibacterial responses, making them a potentially valuable option for ageing people with MS.
(Scientific sources: Refs 1-8)
Prof. Sven Meuth, Germany
MS therapies are part of the standard of care – nevertheless immunosenescence and inflamm-aging still have to be considered
In the younger immune system, the output of adaptive and innate immune cells from hematopoietic stem cells is well-balanced. As time goes by, however, the balance shifts towards innate immunity. Whereas T cells and B cells become fewer and their role decreases, typical innate immune system cells such as macrophages, microglial cells and dendritic cells become more prevalent. This is a normal process of ageing and called immunosenescence. In patients with MS, inflamm-aging accelerates the process of immunosenescence…
Hear Sven Meuth, professor of Neurology at the University of Düsseldorf with a research focus in neuroimmunology, elaborate further on the consequences of these processes for patients with MS, and explain why not all MS drugs may be suitable throughout all periods of life.
(Scientific sources: Refs 3,6,8-16)
Prof. Magd Zakaria, Egypt
MS and co-morbidities – what should we pay particular attention to?
Magd Zakaria is a professor of Neurology at Ain Shams University in Cairo, Egypt. He presents the case of a female patient in her mid-thirties who suffers from hypertension and type 2 diabetes as well as MS. Clinical and radiological data show her to have mild to moderate disease activity. Professor Zakaria explains what he pays particular attention to when taking care of a patient like this of childbearing age with concomitant physical disease, with a short overview of the available evidence regarding MS and co-morbidities.
“Many of the current DMTs may not be suitable for patients with diabetes mellitus and/or hypertension with the risk of increasing vascular complication or infections.”
Professor Zakaria considers interferon beta an effective therapy with a well-known risk profile for such a patient.
(Scientific sources: Refs 17-27)
Prof. Magd Zakaria, Egypt
A MS patient has just turned 50 – time for a reassessment?
In this video Professor Magd Zakaria from the Ain Shams University in Cairo, Egypt presents a case typically seen in a neurological practice: the male patient is 50 years old, was diagnosed with relapsing MS 13 years ago, and has been treated with Betaferon ever since. He has been relapse-free for the last four years, and his EDSS is stable at 2.5 to 3.0.
“He is asking a very important question, whether he should continue taking his medication or not.”
Professor Zakaria highlights registry data from MS Base about treatment discontinuation in clinically stable patients who had been relapse-free for 5 years; stopping treatment led to increased disability progression compared with continued therapy . The background to this and further considerations regarding patients like these can be found in the video...
Prof Gereon Nelles, Germany
The aging MS populations – challenges for the clinical neurologist
Professor Gereon Nelles is a clinical neurologist working in a hospital-based group practice in Cologne, Germany. He has consultations with some 600 to 800 patients with MS each year, about a quarter of whom will be over 50 years of age.
In the first video, Professor Nelles summarizes what has led to the increased longevity of patients with MS over the years. He provides insights into the pathology of MS when patients get older: “One hallmark is the transition of the disease from a predominantly inflammatory to a more neurodegenerative type of pathology.” … and he points to numerous questions regarding the treatment of older MS patients which clinical neurologists should address and develop answers to.
In the second video, Professor Nelles discusses the medical needs of middle-life and older patients with MS and the relevant implications for treating patients with MS whose immune system has aged. “It is unlikely that patients over 55 years of age will benefit from highly intensive therapies. ...Platform therapies such as the interferons may be useful in those elderly people that continue to show inflammatory activity.” He believes that well-designed studies in older patients are urgently needed to guide clinical decision making.
(Scientific sources Refs 8,14,16,29)
Prof. Anthony Reder, USA
MS is incredibly complex – interferons act at several levels
A renowned neuroimmunology expert, Professor Anthony Reder of the University of Chicago is skilled in explaining complex immune processes in a readily understandable manner. Professor, MS clinician and researcher, he provides an insight into the immunopathogenesis of MS and the various targets of interferon beta.
“MS is incredibly complex – clinically, therapeutically, and in its immune and gene regulation. Interferon, a protein with very complex actions, corrects many of the abnormalities in MS.”
(Scientific sources: Refs 4,30-36)
- BETAFERON® European Summary of Product Characteristics, October 2020. Available at: https://www.ema.europa.eu/en/documents/product-information/betaferon-epar-product-information_en.pdf. Accessed on: February 3, 2022. Return to content
- Duszczyszyn DA et al. J Neuroimmunol 2010; 221(1-2): 73-80. Return to content
- Gomez CR et al. Exp Gerontol 2008: 43(8): 718-28. Return to content
- Kasper LH, Reder AT. Ann Clin Transl Neurol 2014; 1(8): 622-31. Return to content
- Lord JM. Hum Vaccin Immunother 2013; 9(6): 1364-7. Return to content
- Mills EA, Mao-Draayer Y. Mult Scler 2018; 24(8): 1014-22. Return to content
- Musella A et al. Front Aging Neurosci 2018; 10: 238. Return to content
- Schweitzer F et al. Curr Opin Neurol 2019; 32(3): 305-12. Return to content
- Grebenciucova E, Berger JR. Curr Neurol Neurosci Rep 2017; 17(8): 61. Return to content
- Kollmann TR et al. Immunity 2012; 37(5): 771-83. Return to content
- Salminen A. J Mol Med (Berl) 2021; 99(11): 1553-69. Return to content
- Simon AK et al. Proc Biol Sci 2015; 282(1821): 20143085. Return to content
- Sun D et al. Cell Stem Cell 2014; 14(5): 673-88. Return to content
- Weideman AM et al. Front Neurol 2017; 8: 577. Return to content
- Wiendl H et al. Ther Adv Neurol Disord 2021; 14: 17562864211039648. Return to content
- Vaughn CB et al. Nat Rev Neurol 2019; 15(6): 329-42. Return to content
- Jakimovski D et al. Eur J Neurol 2019; 26(1): 87-e8. Return to content
- Kowalec K et al. Neurology 2017; 89(24): 2455-61. Return to content
- Magyari M, Sorensen PS. Front Neurol 2020; 11: 851. Return to content
- Marrie RA et al. Neurology 2009 Jan 13; 72(2): 117-24. Return to content
- Marrie RA al. Neurology 2010; 74(13): 1041-7. Return to content
- Marrie RA et al. Neurology 2015; 85(3): 240-7. Return to content
- Marrie RA et al. Mult Scler Relat Disord 2020; 40: 101987. Return to content
- Yadav V. Multiple Sclerosis Centers of Excellence of the U.S. Department of Veteran Affairs. Available at: https://www.va.gov/MS/Veterans/research/Vascular_Disease_Risk_Factors_and_Multiple_Sclerosis.asp Accessed on: February 3, 2022. Return to content
- Yamout B et al. Mult Scler Relat Disord 2020; 37: 101459. Return to content
- Zhang T et al. Neurology 2016; 86(14): 1287-95. Return to content
- Zhang T et al. Neurology 2018; 90(5): e419-27. Return to content
- Kister I et al. J Neurol Neurosurg Psychiatry 2016; 87(10): 1133-7. Erratum in: J Neurol Neurosurg Psychiatry 2019; 90(4): e2. Return to content
- Montalban X et al. Mult Scler 2018; 24(2): 96-120. Return to content
- Baecher-Allan C et al. Neuron 2018; 97(4): 742-68. Return to content
- Dendrou CA et al. Nat Rev Immunol 2015; 15(9): 545-58. Return to content
- Feng X et al. J Neuroimmunol 2002; 129(1-2): 205-15. Return to content
- Feng X et al. EBioMedicine 2019; 49: 269-83. Return to content
- Filippi M et al. Neurology 2011; 76(14): 1222-8. Return to content
- Kieseier BC. CNS Drugs 2011; 25(6): 491-502. Return to content
- Wiendl H, Kieseier BC. Expert Opin Investig Drugs 2003; 12(4): 689-712. Return to content