Hormone therapy may boost disease activity in older MS men
Increases, not expected decreases, found with androgens in small study
Older men with multiple sclerosis (MS) who use medicines that reduce the levels of androgens, or male sex hormones, experience sustained or increased disease activity instead of the expected decreases that typically happen with advancing age, a small study suggests.
According to the team, such disease activity was “particularly” seen among men ages 65 and older.
These findings, the researchers say, suggest that older male patients, who would normally require less intensive follow-up, should continue to be monitored closely if they are using, or have recently used, androgen-modifying therapies, known as AMTs. These medications are widely prescribed to treat prostate diseases and male pattern hair loss.
“In this study, we demonstrated that [male patients with] MS who used AMT were more prone to inflammatory disease activity compared to [those] who did not use [androgen therapies] during and beyond the sixth decade,” the researchers wrote.
The study, “Effects of androgen modifying therapies on disease activity in older men with multiple sclerosis,” was published in the Journal of Neuroimmunology by a team of U.S. and Canadian researchers.
Biological sex is known to affect the development of MS. For example, the disease is three times more common in women than men, and female patients also tend to develop the disease earlier and have more frequent relapses than their male counterparts. Men with MS, meanwhile, tend to have poorer recovery from relapses, and experience faster disability accumulation in the early stages of the disease.
Male sex hormones such as testosterone are known to have anti-inflammatory properties, which may explain, in part, the sex-related differences seen in MS. However, AMTs, which reduce androgen levels, are widely used to treat prostate diseases, such as prostate cancer and enlargement of the prostate gland, and male pattern hair loss.
Because ATMs suppress anti-inflammatory androgens, a team led by scientists at the Mayo Clinic in Minnesota wanted to assess whether exposure to these medications could boost MS inflammatory activity in older men.
Study focused on MS men ages 65 and older
To that end, the researchers reviewed medical records from 60 MS men who started using AMTs at a mean age of 65, and were followed for several years before and after treatment. A group of 80 men with MS but without a history of AMT exposure were included as controls. All participants were ages 55 and older.
The team looked for new lesions, or signs of inflammatory nerve damage, on MRI scans, as well as the occurrence of relapses, before and after the age at which AMT was started.
Among those who didn’t receive AMTs, there was a notable decline over time in the proportion of patients with new lesions (46.2% to 40%), relapses (38.5 % to 10%), and overall disease activity (62.8% to 40%), defined as any new lesions and/or relapses.
This finding was expected, the scientists noted, because inflammatory responses tend to decrease with age, leading to less MS disease activity.
In those treated with ATMs, however, the proportion of patients with new lesions increased, from 35.2% to 46.7%. The proportion of patients with relapses declined, from 33.3% to 22.2%, but not by the same degree as in untreated patients. This ultimately meant that disease activity was sustained (51.9% to 51.1%).
When the team matched patients for disease duration, which can influence this metric, the likelihood of disease activity was higher in the AMT group than in the control group after three years (40% vs. 29%). While these differences were not statistically significant, the number of disease activity events was relatively small and, thus, underpowered to detect significant differences, the team noted.
Importantly, in the management of [people with] MS and prostate disease with AMT consideration, the clinical follow-up should be closer.
The researchers noted that these results call only for closer monitoring.
“Our study would not suggest a contraindication for AMT use in older men with MS,” the team wrote. “However, with any unexpected disease activity (new relapse or new lesion development) in older men with MS, recent AMT use should be reviewed.”
For patients, “closer monitoring … would provide a timely and effective intervention if needed,” the researchers noted.
“Importantly, in the management of [people with] MS and prostate disease with [androgen-modifying therapy] consideration, the clinical follow-up should be closer,” the scientists wrote.
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