Late-onset MS linked to relapse-free disability progression: Study
Findings highlight the need to consider age at onset as a key prognostic factor
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A younger woman is shown with her hand on the shoulder of an older woman as they sit together.
- Late-onset multiple sclerosis (LOMS) is linked to faster disability progression.
- Disability in LOMS often progresses independently of relapses or MRI activity.
- Current treatments may not fully address LOMS progression; age at onset is a key factor.
People who develop multiple sclerosis (MS) at age 50 or later are more likely to accumulate disability through mechanisms that are not directly linked to relapses or MRI activity than those with earlier-onset disease, according to an Italian registry study.
“This suggests that the adverse prognostic effect of [late-onset MS] is driven predominantly by progression mechanisms that are not fully captured by overt inflammatory activity,” researchers wrote.
The study, “Late-onset multiple sclerosis is associated with relapse-independent disability accrual: a propensity score-weighted recurrent-event study,” was published in the Journal of Neurology.
Late-onset MS associated with faster disability accumulation
MS usually begins in early or middle adulthood, but about 5% to 12% of patients have late-onset MS (LOMS), usually defined as onset at or after 50 years of age. Compared with adult-onset MS (AOMS), LOMS usually has less typical inflammatory features and is associated with faster disability accumulation.
Because differences in inflammation cannot fully explain the more severe disease course in these patients, researchers believe that aging-related mechanisms, including increased nerve cell vulnerability, reduced ability to repair nerve damage, and the natural deterioration of the immune system, may contribute to faster disease progression.
To validate this, researchers in Italy investigated whether age at onset influences how disability accrues in people with MS. The team analyzed data from 888 people with relapsing-remitting MS included in the Ravenna Multiple Sclerosis Registry. Among them, 759 had AOMS and 129 had LOMS.
The researchers focused on three disability outcomes: confirmed disability worsening (CDW), defined as a sustained increase in disability scores lasting at least six months; progression independent of relapse activity (PIRA), which refers to CDW occurring in the absence of a relapse; and progression independent of relapse and MRI activity (PIRMA), defined as CDW in the absence of relapses, new or enlarging lesions, or lesions with active inflammation.
These findings highlight the need to consider age at onset as a key prognostic factor and suggest that current monitoring strategies based predominantly on inflammatory activity may be insufficient in this subgroup.
Results showed that all three disability outcomes occurred in a greater proportion of people with LOMS. About 30.3% of patients with AOMS versus 39.8% with LOMS experienced CDW, while PIRA was observed in 20.2% with AOMS and 37% with LOMS. PIRMA was seen in 16.3% and 32.2% of people with AOMS and LOMS, respectively.
After adjusting for confounding variables such as sex, initial disability scores, and initial symptoms, rates of CDW became similar in the two groups. However, LOMS remained significantly associated with a higher risk of relapse-independent disability progression, with a 55% increased risk of PIRA and a 63% increased risk of PIRMA compared with AOMS.
When MRI and spinal fluid biomarkers were added to the models, the association with PIRA remained significant, while the link with PIRMA was weaker or lost significance.
Notably, the association between LOMS and worse disability outcomes remained evident even in patients taking high-efficacy disease-modifying therapies.
“This observation is consistent with recent evidence suggesting that anti-inflammatory treatments, although highly effective in reducing relapse activity and MRI inflammation, may have limited impact on progression independent of relapse activity,” the researchers wrote. “These findings highlight the need to consider age at onset as a key prognostic factor and suggest that current monitoring strategies based predominantly on inflammatory activity may be insufficient in this subgroup.”
ERIC EUGENE EISENHAUER
My wife, Nancy was diagnosed with MS after the age of 60. She is now 75 and has been bed bound, unable to move any part of her body except her head for the last 15 years. She has had many MRI's of the brain and spinal cord over the years and none of them have shown any new lesions. Her Neurologist in San Antonio told us that she has never seen a patient go down hill as fast as Nancy did with her disability progression. That was from a doctor who had 2200 MS patients. That's a record you don't want to hold. Nancy was the first person in our city to start on Ocrevus infusions and she still takes those every 6 months. She gets quarterly botox injections to keep her muscles from tightening up so it is easier for me to do transfers to the bedside commode, shower chair, wheelchair and in and out of our car.
Thomas E McHale
My LOMS seems to be an infection. I am slowly improving without any MS meds. Sleep, high protein nutrition and prayer are mainstays. I have tried Gilenya (better) and Ocrevis (worthless).
Suzanne Paulson
I am a MS white female age 83. Onset of my condition at the age of 55. Physically I still walk with a cane and sometimes with a walker. I have not taken any medication for over 15 years as I never found anything that worked. I have remained fairly stable over the years. Age might slow down progression.
Jody D
I was diagnosed with RRMS 6 1/2 years ago at age 45. Despite not meeting the criteria for LOMS, at diagnosis My EDSS score was 1.5 and now is already 6.5. I’m a RN and would argue with my neurologist that I believed my diagnosis was PPMS because I’ve never had a relapse with a moderate lesion load in my brain that extends down through my cerebellum and brain stem into my cervical spine and ending at T2. I think I’ve experienced just about everything there is to experience with the exception of optic neuritis. I’ve been on Kesimpta for the last 4 years and While I’m still progressing, it has slowed considerably since starting Kesimpta. EDSS score was 6.0 when I started it and now just 6.5. I would consider my experience to be in line with LOMS despite being diagnosed at age 45. These are the averages and/or research criteria but shouldn’t be considered to be applicable for everyone.
Jane Vorndran
I was diagnosed at age 55 (now 67). My neuro keeps trying to "reassure" me as no changes have been in my MRIs for years. I keep telling them about my changes and I get discounted because of the MRIs. It frustrates me because I know how I feel!
Sondra Moreno
I don't know. I feel like I got something, but I'm not sure tired very tired a lot of lower abdominal problems pain constipation bleeding GUMS! Pain in my legs, arthritis pain, sciatica, heart ♥️ Tacacardia