https://doi.org/10.55788/96b83a3c
With age, the inflammatory aspect of MS diminishes, neurodegeneration predominates, and the risk of infections related to the use of disease-modifying therapy (DMT) increases. This has fuelled discussions about the optimal management of MS in older patients, including de-escalating or terminating DMT. However, all landmark trials of MS have excluded patients >60 years of age; therefore, comparative data on high-efficacy DMTs in this group is lacking.
Dr Yi Chao Foong (Monash University, Australia) and colleagues set out to evaluate the comparative effectiveness of ocrelizumab, a high-efficacy DMT, versus interferon or glatiramer acetate in MS patients >60 years of age [1]. Primary outcomes were time to first relapse and annualised relapse rate (ARR). Secondary outcomes were 6-month CDP and confirmed disability improvement (CDI). Using data from the MSBase registry, they formed a multicentre cohort study of 675 eligible patients; 248 received ocrelizumab, 427 received either interferon or glatiramer acetate.
In the ocrelizumab group, there were 8 relapses over a median follow-up of 2.47 years. In the interferon/glatiramer acetate group, there were 182 relapses over a median follow-up of 4.48 years. The inverse probability of treatment weighting (IPTW) ARR and IPTW ARR ratio (0.15; 95% CI 0.06–0.33; P<0.01) significantly favoured ocrelizumab. The cumulative IPTW HR for time to first relapse was 0.12 (95% CI 0.05–0.26; P<0.01). The relative risk of first relapse was significantly increased in interferon/glatiramer acetate users after 5 months. There was no difference between treatment groups in the secondary outcomes. However, the CDP/CDI analysis was limited by a significant loss of power and lack of data on co-morbidities.
Dr Foong concluded that this study adds valuable real-world data that allows for a nuanced discussion with older patients about benefits versus risks of their treatments.
- Foong YC, et al. Comparing ocrelizumab to interferon/glatiramer acetate in people with multiple sclerosis over age 60. O045, MSMilan 2023, 11–13 October, Milan, Italy.
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Table of Contents: MSMilan 2023
Featured articles
Letter from the Editor
Real-world data supports ocrelizumab prior to conception
Progressive MS
Early initiation of highly active treatment associated with a lower risk of SPMS
Ocrelizumab more effective than interferon/glatiramer acetate in older MS patients
Paediatric MS
Prioritising high efficacy therapies in children with MS
Omega-3 polyunsaturated fatty acids associated with lower risk of MS activity
NMOSD & MOGAD
An update on evolving treatment algorithms for NMOSD and MOGAD
Women’s Health
Rate of grey matter brain atrophy accelerates after menopause
Real-world data supports ocrelizumab prior to conception
Miscellaneous
New insights into the contribution of EBV to MS pathogenesis
COVID-19 infection associated with higher MS relapse rate
Telerehabilitation effective in improving MS symptoms in patients with moderate disability
Curing MS
Understanding what an MS cure means and what it takes
Prodromal MS
Progressive brain tissue loss precedes the onset of clinical MS by years
Sickness absence rate increases years before clinical onset of MS
Treatment Trials and MS Strategies
Early intensive treatment enhances long-term clinical outcomes
Oral glycolipid shows promise in the treatment of MS, especially SPMS
Fenebrutinib shows rapid reduction of new Gd+ T1 lesions
Challenges of de-escalation versus discontinuation of highly effective DMTs in older MS patients
Biomarkers & Imaging
χ-separation can assess the effects of tissue destruction in early MS lesions
High sGFAP levels are associated with disease progression, independent of NfL or relapse activity
Broad rim lesions correlate with a rapidly progressive MS phenotype
Smouldering inflammation detectable even in the earliest stages of MS
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