MSBase study links DMT-associated disability outcomes to age in relapsing MS

A population-based longitudinal analysis of 15,425 adults in the international MSBase registry examined disability transitions by age and treatment category. Disease-modifying therapies were associated with less disability progression, but estimated benefit declined with age; the observational findings do not establish causation.

Registry analysis included 15,425 adults with relapse-onset MS.
DMT use was associated with more favourable disability trajectories.
Estimated benefit declined with age, especially after 50.
Observational findings do not establish causal treatment effects.

Researchers analysed longitudinal MSBase registry data for 15,425 adults with relapse-onset multiple sclerosis, each with at least 12 months of follow-up and two relapse-remote EDSS assessments. A continuous-time multistate model assessed transitions among five disability states, including secondary progressive MS, and compared low- and high-efficacy disease-modifying therapies (DMTs) with no treatment. Median follow-up was 9.4 years; 87.9% of participants received a DMT.

Both DMT categories were associated with more favourable disability trajectories across most transitions, including a greater likelihood of improvement. Estimated treatment effects were strongest among adults aged 18–30 years, attenuated through ages 30–50, and were weaker or inconclusive after age 50, particularly for transitions to secondary progressive MS. High-efficacy therapy was associated with greater inhibition of progression than low-efficacy therapy, with evidence of benefit persisting into older age. The model also identified rapid-worsening and stable/improving subgroups, comprising 76.1% and 23.9% of participants, respectively.

These real-world associations suggest that age and variation in progression risk may be relevant when interpreting DMT outcomes. Because this was an observational analysis, treatment effects may be influenced by differences between treated and untreated patients; the findings do not establish that age should determine treatment choice.

In practice

For adults with relapse-onset MS, this large observational registry analysis found that DMT use was associated with more favourable disability trajectories, with estimated effects strongest at younger ages and weaker or inconclusive after age 50, particularly for transitions to secondary progressive MS. High-efficacy therapy showed greater estimated inhibition of progression than low-efficacy therapy. These results may inform interpretation of real-world outcomes, but they do not establish causation or support changing treatment solely on the basis of age; residual differences between treatment groups may affect the associations.

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Source

BMC Medicine: Disease-modifying therapies in managing disability worsening in adult relapsing multiple sclerosis: a population-based longitudinal study using the MSBase registry ↗

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