Experts call for better care, research tailored for older MS patients
Clinical management of aging MS patients 'requires urgent refinement'
Experts are calling for tailored strategies to enhance the diagnosis, treatment, and monitoring of older people with multiple sclerosis (MS).
As people with MS live longer, age-related biological changes increasingly complicate diagnosing and managing the disease in older adults. No universal framework currently guides how to address these unique challenges.
“As the global population of people with MS ages, the clinical management of people with MS [50 years or older] requires urgent refinement,” researchers wrote. “To address these challenges, collaborative research, inclusive trial design and patient-centred care models must be prioritized.”
The study, “Advancing multiple sclerosis management in older adults,” was published in Nature Reviews Neurology.
MS, a neurodegenerative disease, has a typical onset in early or middle adulthood, but advances in care mean that people diagnosed with MS in early adulthood are living longer lives. An increasing proportion of MS cases is being diagnosed after age 50.
More than half of people living with MS are 50 years or older
According to recent data, more than half of people living with MS are at least 50 years old. This aging MS population brings new challenges to care, and currently lacks consensus guidelines on disease management.
To address this, the International Advisory Committee on Clinical Trials in MS held an expert workshop, including a diverse group of clinical experts, people with MS, and representatives for advocacy organizations. The recently published consensus summarizes insights from the workshop and offers recommendations to drive progress in the diagnosis, monitoring, and treatment of older MS patients.
In the report, the group emphasized the many challenges that exist in MS care for older individuals. At issue is the need to understand how typical aging processes interact with MS disease processes at the biological level.
Diagnosing MS in older people can be difficult because the disease tends to present differently with age — for example, older people are more likely to have a progressive form of the disease, and age-related coexisting conditions (comorbidities) can further complicate that clinical picture. As such, the diseases that need to be ruled out to confirm an MS diagnosis will differ.
Disease monitoring also comes with new challenges, because aging itself impacts several different imaging, clinical, and laboratory biomarkers that are typically used to track how MS is progressing.
“Existing diagnostic tools, biomarkers and outcome measures often fail to capture the complexity of MS in older adults,” the group wrote, emphasizing a key need for research to develop new tools.
MS treatment paradigms for older people also need work, according to the team. Clinical trials for MS disease-modifying therapies (DMTs) have often excluded older individuals and people with comorbidities, making it difficult to understand the true safety and efficacy of these medications in an aging MS population.
Also, many DMTs target a form of focal inflammation that may not be as prominent in older people due to age-related immune system changes.
Information is also limited on when to safely switch and discontinue medications in older people.
Need for clinical trials that don’t exclude based on age, comorbidities
This emphasizes a critical need for innovative clinical trial designs that don’t exclude people on the basis of age or comorbidities, according to the authors. Patient registries and observational studies can also provide valuable real-world data.
Finally, the team pointed out that older people with more disability have limited access to health services and require more social assistance than younger people, particularly among racial and ethnic minorities.
“These contextual factors must be considered to enable development of effective management strategies,” they wrote. “Patient empowerment through effective communication, engagement and access to resources is an important element of management.”
The group also offered a wide range of other recommendations, including research-based efforts, changes in clinical paradigms, and awareness initiatives that will overall make it easier to diagnose, monitor, and treat older individuals with MS.
While some of their recommendations — such as raising awareness and increasing resources for patients — can be achieved quickly, others, such as clinical trial redesign, will take time.
To reach these goals, the team suggests the formation of focused task groups developed in consultation with older people with MS.
“This Consensus statement offers expert-driven recommendations to guide the next phase of research and practice to improve outcomes for older people with MS,” the team wrote.
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