Tumani Hayrettin, Coyle Patricia K, Cárcamo Claudia, Cordioli Cinzia, López Pablo A, Peterka Marek, Ramo-Tello Cristina, Zuluaga María I, Koster Thijs, Vignos Megan
Department of Neurology, University of Ulm, Ulm, Germany.
Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
Mult Scler J Exp Transl Clin. 2023 Sep 13;9(3):20552173231198588. doi: 10.1177/20552173231198588. eCollection 2023 Jul-Sep.
People over age 50-55 have historically been excluded from randomized clinical trials for multiple sclerosis (MS). However, more than half of those living with an MS diagnosis are over 55.
Explore the unique considerations of treating older people with MS (PwMS) using an iterative and structured Delphi-based assessment to gather expert opinions.
Eight MS neurologists with an interest in older PwMS developed a 2-round survey. Survey respondents were qualified neurologists with ≥3 years' experience, personally responsible for treatment decisions, and treating ≥20 patients per month, of whom ≥10% were ≥50 years old. Consensus was defined as ≥75% agreement on questions with categorical responses or as a mean score ≥4 on questions with numerical responses.
In Survey 1, 224 neurologists responded; 180 of these completed Survey 2. Limited consensus was reached with varying levels of agreement on several topics including identification and assessment of older patients; factors relating to treatment decisions including immunosenescence and comorbidities; considerations for high-efficacy treatments; de-escalation or discontinuation of treatment; effects of COVID-19; and unmet needs for treating this population.
The results of this Delphi process highlight the need for targeted studies to create guidance for the care of older PwMS.
50 - 55岁以上的人群历来被排除在多发性硬化症（MS）的随机临床试验之外。然而，被诊断为MS的患者中，超过一半年龄在55岁以上。
采用基于德尔菲法的迭代式结构化评估来收集专家意见，探讨治疗老年多发性硬化症患者（PwMS）的独特考量因素。
八位对老年PwMS感兴趣的MS神经科医生开展了两轮调查。调查对象为具备至少3年经验、亲自负责治疗决策且每月治疗至少20名患者（其中至少10%年龄在50岁及以上）的合格神经科医生。对于分类回答的问题，共识定义为至少75%的一致意见；对于数值回答的问题，共识定义为平均得分至少为4分。
在第一轮调查中，224名神经科医生做出回应；其中180人完成了第二轮调查。在几个主题上达成了有限的共识，不同主题的一致程度有所不同，这些主题包括老年患者的识别与评估；与治疗决策相关的因素，包括免疫衰老和合并症；高效治疗的考量因素；治疗的降级或中断；COVID - 19的影响；以及治疗该人群未满足的需求。
该德尔菲法的结果凸显了开展针对性研究以为老年PwMS的护理制定指导意见的必要性。
