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Journal of Neurology

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01-09-2021 | Multiple Sclerosis | Original Communication

Late-onset MS is associated with an increased rate of reaching disability milestones

Authors: Mads Albrecht Andersen, Mathias Due Buron, Melinda Magyari

Published in: Journal of Neurology | Issue 9/2021

Abstract

Objective

To describe patient characteristics and assess the risk of disability worsening in patients of different age groups with focus on late-onset multiple sclerosis (LOMS) defined as disease onset after the age of 50 years.

Methods

The nationwide population-based Danish Multiple Sclerosis Registry served as data source. We described baseline characteristics and analyzed rates of reaching Expanded Disability Status Scale (EDSS) milestones.

Results

We identified 28,232 patients with MS with a known year of clinical onset, of which 2661 had LOMS. The LOMS group had a higher proportion of males and patients with primary progressive disease course, and they were less likely to receive disease-modifying therapy. The initial rate of reaching EDSS milestone 6 after diagnosis was higher in LOMS [hazard ratio (HR) 1.53; 95% confidence interval (CI) 1.14–2.06]; however, when assessing the risk of reaching EDSS 6 according to age, the HR was significantly lower for the LOMS group (HR 0.307; 95% CI 0.221–0.426).

Conclusion

The clinical characteristics and treatment approaches for patients with LOMS differ from their younger counterparts. Following diagnosis, patients with LOMS initially have an increased rate of reaching EDSS score 6; however, the risk of reaching EDSS score 6 at any given age is higher in patients with non-LOMS.

Koch-Henriksen N, Thygesen LC, Stenager E et al (2018) Incidence of MS has increased markedly over six decades in Denmark particularly with late onset and in women. Neurology 90:e1954–e1963. https://doi.org/10.1212/WNL.0000000000005612CrossRefPubMed

D’Amico E, Patti F, Zanghì A et al (2018) Late-onset and young-onset relapsing-remitting multiple sclerosis: evidence from a retrospective long-term follow-up study. Eur J Neurol 25:1425–1431. https://doi.org/10.1111/ene.13745CrossRefPubMed

Koch-Henriksen N, Laursen B, Stenager E, Magyari M (2017) Excess mortality among patients with multiple sclerosis in Denmark has dropped significantly over the past six decades: a population based study. J Neurol Neurosurg Psychiatry 88:626–631. https://doi.org/10.1136/jnnp-2017-315907CrossRefPubMed

Lunde HMB, Assmus J, Myhr KM et al (2017) Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study. J Neurol Neurosurg Psychiatry 88:621–625. https://doi.org/10.1136/jnnp-2016-315238CrossRefPubMed

Martinelli V, Rodegher M, Moiola L, Comi G (2004) Late onset multiple sclerosis: clinical characteristics, prognostic factors and differential diagnosis. Neurol Sci 25:S350–S355. https://doi.org/10.1007/s10072-004-0339-8CrossRefPubMed

Bove R, Chitnis T (2013) Sexual disparities in the incidence and course of MS. Clin Immunol 149:201–210CrossRef

Polliack ML, Barak Y, Achiron A (2001) Late-onset multiple sclerosis. J Am Geriatr Soc 49:168–171. https://doi.org/10.1046/j.1532-5415.2001.49038.xCrossRefPubMed

Peterson JW, Trapp BD (2005) Neuropathobiology of multiple sclerosis. Neurol Clin 23:107–129CrossRef

Amato MP, Fonderico M, Portaccio E et al (2020) Disease-modifying drugs can reduce disability progression in relapsing multiple sclerosis. Brain 143:3013–3024. https://doi.org/10.1093/brain/awaa251CrossRefPubMed

10.

Trojano M, Tintore M, Montalban X et al (2017) Treatment decisions in multiple sclerosis—insights from real-world observational studies. Nat Rev Neurol 13:105–118. https://doi.org/10.1038/nrneurol.2016.188CrossRefPubMed

11.

Magyari M, Joensen H, Laursen B, Koch-Henriksen N (2020) The Danish Multiple Sclerosis Registry. Brain Behav. https://doi.org/10.1002/brb3.1921CrossRefPubMedPubMedCentral

12.

Korn EL, Graubard BI, Midthune D (1997) Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 145:72–80. https://doi.org/10.1093/oxfordjournals.aje.a009034CrossRefPubMed

13.

Thiébaut ACM, Bénichou J (2004) Choice of time-scale in Cox’s model analysis of epidemiologic cohort data: a simulation study. Stat Med 23:3803–3820. https://doi.org/10.1002/sim.2098CrossRefPubMed

14.

Noseworthy J, Paty D, Wonnacott T et al (1983) Multiple sclerosis after age 50. Neurology 33:1537–1544. https://doi.org/10.1212/wnl.33.12.1537CrossRefPubMed

15.

Bove RM, Healy B, Augustine A et al (2012) Effect of gender on late-onset multiple sclerosis. Mult Scler J 18:1472–1479. https://doi.org/10.1177/1352458512438236CrossRef

16.

Kister I, Chamot E, Cutter G et al (2012) Increasing age at disability milestones among MS patients in the MSBase Registry. J Neurol Sci 318:94–99. https://doi.org/10.1016/j.jns.2012.03.017CrossRefPubMed

17.

Ontaneda D (2019) Progressive multiple sclerosis. Contin Lifelong Learn Neurol 25:736–752. https://doi.org/10.1212/CON.0000000000000727CrossRef

18.

Buron MD, Chalmer TA, Sellebjerg F et al (2020) Initial high-efficacy disease-modifying therapy in multiple sclerosis. Neurology 95:e1041–e1051. https://doi.org/10.1212/WNL.0000000000010135CrossRef

19.

Tremlett H, Zhao Y, Joseph J et al (2008) Relapses in multiple sclerosis are age- and time-dependent. J Neurol Neurosurg Psychiatry 79:1368–1374. https://doi.org/10.1136/jnnp.2008.145805CrossRefPubMed

20.

Alroughani R, Akhtar S, Ahmed S et al (2016) Is time to reach EDSS 6.0 faster in patients with late-onset versus young-onset multiple sclerosis? PLoS ONE. https://doi.org/10.1371/journal.pone.0165846CrossRefPubMedPubMedCentral

21.

Guillemin F, Baumann C, Epstein J et al (2017) Older age at multiple sclerosis onset is an independent factor of poor prognosis: a population-based cohort study. Neuroepidemiology 48:179–187. https://doi.org/10.1159/000479516CrossRefPubMed

22.

Tremlett H, Devonshire V (2006) Is late-onset multiple sclerosis associated with a worse outcome? Neurology 67:954–959. https://doi.org/10.1212/01.wnl.0000237475.01655.9dCrossRefPubMed

23.

Sormani MP, Tintorè M, Rovaris M et al (2008) Will Rogers phenomenon in multiple sclerosis. Ann Neurol 64:428–433. https://doi.org/10.1002/ana.21464CrossRefPubMed

Title: Late-onset MS is associated with an increased rate of reaching disability milestones
Authors: Mads Albrecht Andersen
Mathias Due Buron
Melinda Magyari
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keyword: Multiple Sclerosis
Published in: Journal of Neurology / Issue 9/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-021-10490-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Late-onset MS is associated with an increased rate of reaching disability milestones

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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