Disease course of MS patients when they age

With age, relapses may become less frequent, while disability may accumulate, but a substantial group of patients remain in the relapsing-remitting phase as they age [1]. For instance, 38% of relapsing-remitting patients from Olmsted County, MN, USA remained in this phase past 75 years of age [1,2], while in the London Ontario cohort, roughly a third of the patients continued to have relapsing-remitting MS as they aged [1,3].

When patients with MS get older their ability to recover from a relapse declines [4,5]. Besides older age, longer MS duration and / or a progressive disease course may negatively impact relapse recovery and disability progression [5,6]. Moreover, in secondary progressive MS, relapses have been associated with a faster rate of disability accumulation [7].

According to experts, ongoing MS activity is a suitable treatment target in MS [4,6,7]

Over the longer run, patients with secondary progressive MS and superimposed relapses seem to benefit from MS therapy [7]. This was the conclusion from a recent data analysis of the international MS Base register. The observational cohort study included 1621 patients with secondary progressive MS, with an average follow up in the SPMS phase of 5.6 years. Superimposed relapses were noted in approximately 40% of patients (661/1621). Interferon beta preparations (followed by glatiramer acetate) were the most used treatments in the early as well as the late phase of MS. Greater receipt of disease-modifying therapies among patients with superimposed relapses was associated with a reduced rate of disability progression and a lower risk of becoming wheelchair dependent [7]. Likewise, a recent post-hoc analysis from phase 3 studies found that the effects of interferon beta-1a on clinical and MRI parameters were preserved in patients transitioning between relapsing-remitting and secondary progressive MS [8].