From the Department of Clinical Neuroscience (E.F.M., E.M., A.B., K.A.M., J.H., E.I.), and Centre for Molecular Medicine (J.H.), Karolinska Institutet; and Department of Neurology (E.M., K.A.M., E.I.), Stockholm, Sweden.
Neurology. 2024 Mar 26;102(6):e208051. doi: 10.1212/WNL.0000000000208051. Epub 2024 Feb 23.
Clinical onset of multiple sclerosis (MS) after the age of 50 years is uncommon and associated with a less favorable natural history. The differences in long-term outcomes in patients with late-onset MS (LOMS, onset 50 years or older) and adult-onset MS (AOMS, onset 18 years or older and younger than 50 years) during the disease-modifying therapy (DMT) era have been less studied. This study aimed to compare patient characteristics, DMT exposure, and disability progression in Swedish patients with LOMS and AOMS over 2 decades (2001-2022).
The nationwide Swedish MS registry was searched for patients with an onset of MS between January 1, 2001, and December 31, 2018, with symptom onset at age 18 years or older and ≥2 recorded Expanded Disability Status Scale (EDSS) scores. Clinical and demographic parameters and exposure to DMT were compared between LOMS and AOMS. Time to disability milestones (EDSS 4 and 6) was assessed using Kaplan-Meier curves and Cox proportional hazards regression models adjusted for sex, disease course, calendar year at onset, and DMT exposure.
Among 8739 patients with MS who met inclusion criteria, 1,028 (11.8%) were LOMS. Primary progressive MS was more frequently diagnosed in LOMS compared with that in AOMS (25.2% vs 4.5%; < 0.001). Most of the patients had been prescribed DMT, but more rarely in LOMS compared with AOMS (74.7% vs 95.6%; < 0.001). Less than half of patients with LOMS had been exposed to a high-efficacy DMT (45.8%) compared with 73.5% of AOMS ( < 0.001). The risk of reaching disability milestones was greater for LOMS compared with that for AOMS (EDSS 4; adjusted hazard ratio [aHR] 2.71; 95% CI 2.22-3.30; < 0.001, and EDSS 6; aHR 2.67; 95% CI 2.12-3.36; < 0.001).
This study distinguishes LOMS as a particularly vulnerable group and clinically supports close vigilance of these patients. Further studies are needed to assess and clarify the benefit of DMT usage in older adults with MS.
50 岁以后出现多发性硬化症（MS）的临床发作并不常见，且与更不利的自然病史相关。在疾病修饰治疗（DMT）时代，晚发性 MS（LOMS，发病年龄 50 岁及以上）和成人发病 MS（AOMS，发病年龄 18 岁及以上且小于 50 岁）患者的长期结局差异研究较少。本研究旨在比较 20 年来（2001-2022 年）瑞典 LOMS 和 AOMS 患者的患者特征、DMT 暴露和残疾进展情况。
在全国性瑞典 MS 登记处搜索了 2001 年 1 月 1 日至 2018 年 12 月 31 日期间发病的 MS 患者，发病年龄为 18 岁及以上且至少有 2 次记录的扩展残疾状态量表（EDSS）评分。比较了 LOMS 和 AOMS 之间的临床和人口统计学参数以及 DMT 暴露情况。使用 Kaplan-Meier 曲线和 Cox 比例风险回归模型评估残疾里程碑（EDSS 4 和 6）的时间，该模型调整了性别、疾病过程、发病年份和 DMT 暴露情况。
在符合纳入标准的 8739 名 MS 患者中，有 1028 名（11.8%）为 LOMS。与 AOMS 相比，LOMS 更常诊断为原发性进行性 MS（25.2%比 4.5%；<0.001）。大多数患者接受了 DMT 治疗，但 LOMS 患者接受 DMT 治疗的比例明显低于 AOMS（74.7%比 95.6%；<0.001）。与 AOMS 患者（73.5%）相比，LOMS 患者接受高效 DMT 治疗的比例较小（45.8%；<0.001）。与 AOMS 相比，LOMS 患者达到残疾里程碑的风险更高（EDSS 4；调整后的危险比[aHR] 2.71；95%CI 2.22-3.30；<0.001，和 EDSS 6；aHR 2.67；95%CI 2.12-3.36；<0.001）。
本研究将 LOMS 区分出来作为一个特别脆弱的群体，并在临床上支持对这些患者的密切监测。需要进一步研究来评估和阐明 DMT 在老年 MS 患者中的使用益处。
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