Journal Article: Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review

The article ‘Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review’ was published as open access in the Frontiers Media on the 5th of April 2024.

Authors: Óscar Fernández*^¥1,2, Per Soelberg Sörensen^3,4, Giancarlo Comi^5,6, Patrick Vermersch⁷, Hans-Peter Hartung^8,9,10, Letizia Leocan^5,6, Thomas Berger^11,12, Bart Van Wijmeersch^13,14, Celia Oreja-Guevara^¥15,16

¹Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain. ²Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain. ³Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. ⁴Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. ⁵Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy. ⁶University Vita-Salute San Raffaele, Milan, Italy. ⁷Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France. ⁸Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. ⁹Brain and Mind Center, University of Sydney, Sydney, NSW, Australia. ¹⁰Department of Neurology, Palacky University Olomouc, Olomouc, Czechia. ¹¹Department of Neurology, Medical University of Vienna, Vienna, Austria. ¹²Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria. ¹³University MS Centre, Hasselt-Pelt, Belgium. ¹⁴Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium. ¹⁵Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain. ¹⁶Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.

 ¥ Both authors contributed equally to this work

Abstract

New Review Sheds Light on Managing Multiple Sclerosis in Older Adults

Managing Multiple Sclerosis (MS) in individuals aged 55 and above is becoming increasingly complex, according to a comprehensive new review. The study highlights the unique challenges posed by the interaction of aging, comorbidities, immunosenescence, and MS pathophysiology.

Key Findings:

• Rising Incidence: There is a notable increase in MS cases among older adults, with a shift from relapsing-remitting to progressive disease forms.
• Multimorbidity and Polypharmacy: Many older MS patients face additional health conditions and are on multiple medications, complicating their treatment.

Therapeutic Insights:

• Disease-Modifying Treatments (DMTs): The review evaluates the efficacy and safety of current therapies for older patients. Emerging treatments, including Bruton tyrosine kinase (BTK) inhibitors and drugs targeting remyelination and neuroprotection, show promise.
• Critical Decisions: The study underscores the importance of careful decision-making regarding the initiation, de-escalation, and discontinuation of DMTs.

Holistic Care Approaches:

• Non-Pharmacologic Treatments: Physical therapy, neuromodulation, cognitive rehabilitation, and psychotherapy play crucial roles in comprehensive care.
• MS Care Units and Advance Care Planning: These are essential for providing patient-centric care and ensuring treatments align with patient preferences.

The review also calls for more personalized management and continuous monitoring of MS patients. It advocates for inclusive clinical trial designs that represent a wider age range to enhance treatment strategies for this growing demographic.

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