Siddiqui Areeba, Hua Le H
Southwest Medical Associates, Part of OptumCare, 4475 S Eastern Ave, Las Vegas, NV 89119, USA.
Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106, USA.
Neurotherapeutics. 2025 Jul;22(4):e00603. doi: 10.1016/j.neurot.2025.e00603. Epub 2025 May 2.
Older patients age ≥55 account for almost half of the total MS population. While focal inflammatory demyelinating processes and progressive processes such as compartmentalized CNS inflammation, neurodegeneration, and failure of compensatory mechanisms co-occur from disease onset, there is a shift in the predominant disease processes with notable clinical progression occurring in the fifth decade of life. Clinically, this manifests in reduction in clinical relapses and MRI activity as persons with MS age, with an increase in slow disability progression independent of relapses. As disease modifying therapies have demonstrated efficacy on relapse reduction, but not centrally mediated progressive processes, the benefit of DMT wanes with age due to change in underlying biological disease processes. Contrastingly, risks of DMTs increase due to biological changes related with age, setting up a scenario where considerations on switching or stopping DMT become more clinically important based on risk-benefit ratios. This review will cover evidence regarding DMT use in older patients with MS and discuss age considerations in the management of patients with MS.
年龄≥55岁的老年患者几乎占多发性硬化症（MS）总人口的一半。虽然从疾病发作开始就同时存在局灶性炎症性脱髓鞘过程和进行性过程，如局限性中枢神经系统炎症、神经退行性变和代偿机制衰竭，但随着年龄增长，主要疾病过程会发生转变，在生命的第五个十年会出现明显的临床进展。临床上，这表现为随着MS患者年龄增长，临床复发和MRI活动减少，与复发无关的缓慢残疾进展增加。由于疾病修饰疗法已证明对减少复发有效，但对中枢介导的进行性过程无效，由于潜在生物学疾病过程的变化，DMT的益处会随着年龄增长而减弱。相反，由于与年龄相关的生物学变化，DMT的风险增加，从而形成了一种情况，即基于风险效益比，关于更换或停用DMT的考虑在临床上变得更加重要。本综述将涵盖关于在老年MS患者中使用DMT的证据，并讨论MS患者管理中的年龄因素。
