Age: DMT the earlier you start the better they work

Ageing and MS; is this an important factor to consider when considering DMTs? #MSBlog #MSResearch

“The study below confirms what we know that age is a predictor of response to DMTs. The older you are the lower the effectiveness of a treatment. Interestingly, Maria Pia-Sormani’s group presented a meta-analysis, at the ENS, across all studies showing that age is an important predictor of response to DMTs. The older groups had a lower response rate than younger MSers. What is this telling us? It may tell us that biology of MS changes with time or age-related biological effects have an impact on disease outcomes. We already know that myelination and recovery drops with age. This is in important consideration when we come to thinking about MS; for example, a large component of progressive MS may be premature ageing and at present we have no treatment for this. The message is that if you have active MS you need to get on top of the activity ASAP; the longer you wait, the older you get, and your response rate will drop.”

“Ageing and MS;  this is a really an important issue. I will need to add it to my tube map.”

Epub: Matell et al. Age-dependent effects on the treatment response of natalizumab in MS patients.Mult Scler. 2014 May. pii: 1352458514536085.

BACKGROUND: Natalizumab is approved for treatment of active forms of relapsing-remitting multiple sclerosis (MS) based on a pivotal phase III study comprising MSers aged 18-50 years. The effect of natalizumab has not been specifically studied in older MSers.

OBJECTIVE: We analyzed age-dependent effects on treatment-related outcome measures in 1872 MSers, 189 of whom were aged 50 or more, included in the Swedish post-marketing natalizumab surveillance program.

METHODS: In three MS centers registry data for MSers aged >50 years were validated.

RESULTS: At baseline older MSers had longer disease duration, higher Expanded Disability Status Scale (EDSS) and lower Symbol Digit Modality Test (SDMT) scores than younger MSers. The influence from natalizumab on outcome measures was significantly reduced and 18.7% of MSers >50 years stopped treatment for lack of effect compared to 7.7% in the younger age group. At baseline, the cerebrospinal fluid levels of the chemokine CXCL13 and the leucocyte cell count were negatively correlated with age in a smaller subgroup of MSers.

CONCLUSION: These results were in agreement with previous findings suggesting that inflammation is more pronounced in younger MSers and therefore the beneficial effects of potent anti-inflammatory treatments are subsiding with older ages.

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • From my novice reading, this just seems to be saying that age is a marker for disease duration. We already know that people who have had the disease longer are more likely to be progressive, and as such not respond well to DMTs. Did they control for disease duration, EDSS, etc? It doesn't look like they did.

  • Prof G,

    More depressing stuff from the world of MS research. I'm not sure I'd want you as my neuro as I'd come out of the consultation in tears – I've has MS for over a decade and have moderate disability (a male in early 50s). What advice would you give someone in a similar position (not me of course)? Is there anything on the horizon to give someone in a similar position hope? Are patients in this situation expected to sit back and watch themselves deteriorate while the world carries on? Do any of the trials currently underway (stem cell trials such as STREAMS, or remyelination trials such as antilingo) provide any hope of repair. I could live with EDSS 2, I'm just about coping with 4, but anything more is likely to be the straw which breaks the camels back. I don't want to do something if in 5 years time I might have access to therapies which get me back some of what I have lost. Am I the only one using this blog who thinks this way?

    • This is not a control study every one got Tysabri and they are interrogating the data

      Treatment duration was the following: 1499 patients for ≥6 months, 1274 for ≥12 months, 899 for ≥24 months, 593 for ≥36 months and 316 for ≥48 months, respectively. Average age at time of enrollment was 37.3 years for women and 37.2 for men. Sixty patients were below the age of 20 and 189 above 50 at censoring of data.

    • Thank you, but how long had the patients had MS? How can these statistics not include this information?

  • I empathize with the comment 2 above as I am in a very similar situation. I don't want to shoot the messenger and appreciate that you provide the data you have, I guess if you can't face it you probably shouldn't read it. However I am EDSS 6, and know that any further slippage is the end of the road, that is just MS, it doesn't get better with age!.

  • For me I think it's better to give people the news as honestly as possible and not to sugar coat anything. Knowledge is power and more you have the better you will be set up to deal with the situation, a sympathetic pat on the knee is all very well and needed at some points, but it's not going to give someone the push they mind need. Just my thoughts and not meant to upset anyone.
    Regards as always.

    • Andy,

      I disagree that knowledge is poer, in paticular when the knowledge from rhe experst is "we don't know what causes MS", "we don't know how to repair the damage"…

      Whilst the blog has lots of information it hasn't helped my MS one jot, I'm guessing the same is true for your wife. I want some knowledge that with 3-5 years there will be treatments to repair the damage done. That would be the sor of knowledge that would empower me.

  • Oh and on a side note, I do wonder how close the stem cell boffins are to unlocking the reason for aging ?
    I personally think in terms of Scientific research closer than people realise.
    Regards as always.

  • If you guys were in the US, the odds of a doctor replying to posts would be zero (liability, apathy, etc.). You should be thankful a professional takes time out from teaching, clinical practice, research, etc. to give any sort of personalized response at all. "They" should cure the disease and undo decades of retroactive damage. Well, how much have you donated to research?

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