Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne.
Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany.
Curr Opin Neurol. 2019 Jun;32(3):305-312. doi: 10.1097/WCO.0000000000000701.
A variety of high-efficacy disease-modifying therapies (DMTs) are available for the treatment of multiple sclerosis (MS). After evaluation and approval by regulatory agencies, DMTs are likely to be administered to patients whose characteristics differ from those enrolled in clinical trials. This may contribute to the emergence of unexpected adverse events observed in the real-world setting. Higher age may be a relevant factor that could change the benefit-risk balance of DMTs, as it may associate with lower efficiency and higher frequency of adverse events.
The absolute and relative number of patients with MS who reach the age of 55 and higher increases. Growing evidence demonstrates lower efficacy of DMTs in older persons with MS. Specific risks during DMTs for MS, such as the risk of developing progressive multifocal leukoencephalopathy (PML) or the outcome following PML, have been associated with age. It is hypothesized that age-related and therapy-induced alterations to the immune system may have (super)additive effects, resulting in an acceleration of physiological immunosenescence and inflamm-aging.
In this article, we review the risks of high-efficacy DMTs in MS with a specific focus on age-related efficacy and risks, including opportunistic infections, malignancies, and autoimmune reactions.
多种高效疾病修正疗法（DMT）可用于治疗多发性硬化症（MS）。在监管机构评估和批准后，DMT 可能会被用于与临床试验入组患者特征不同的患者。这可能导致在真实环境中观察到意外的不良反应。年龄较高可能是一个相关因素，可能会改变 DMT 的获益-风险平衡，因为它可能与较低的效率和更高的不良反应频率相关。
达到 55 岁及以上年龄的 MS 患者的绝对和相对数量都在增加。越来越多的证据表明，DMT 在老年 MS 患者中的疗效较低。MS 患者 DMT 期间的特定风险，如进展性多灶性白质脑病（PML）的风险或 PML 后的结果，与年龄有关。据推测，与年龄相关的和治疗诱导的免疫系统改变可能具有（超）相加作用，导致生理免疫衰老和炎症衰老的加速。
在本文中，我们综述了 MS 中高效 DMT 的风险，特别关注与年龄相关的疗效和风险，包括机会性感染、恶性肿瘤和自身免疫反应。
