Response to therapy in a cohort of patients with late-onset multiple sclerosis.

Background and objectives: Late-onset MS (LOMS, symptom onset after age 50) remains underrepresented in clinical trials, leading to a gap in knowledge about the efficacy of disease-modifying therapies (DMTs). This study aims to evaluate treatment outcomes in relapsing LOMS.

Methods: A retrospective electronic medical record study at Northwestern University analyzed patients with LOMS presenting between 2004 and 2021. Demographic, clinical, DMT, and MRI data were extracted. Statistical analyses evaluated progression based on DMT efficacy.

Results: Overall, 63 patients (63% female, 76% white, median onset 55 years) were followed for a median of 7.6 years. Most patients (73%) were started on low/moderate efficacy DMTs (LET/MET). Increasing baseline EDSS was associated with an increased risk of reaching EDSS 6 (P < .001), but increasing age at diagnosis/treatment was not associated with increasing disability attainment (P = .527). Patients on LET/MET had no difference in progression to EDSS 6.0 compared to no DMT (P = .354) or change in Age-Related Multiple Sclerosis Severity Score (ARMSS) from the start of treatment/diagnosis to last follow-up (P = .477).

Discussion: The effect of LET/MET DMTs is less pronounced in older adults and may not significantly impact long-term disability outcomes.