Progressive multiple sclerosis (MS) is simply a later stage of the MS disease process and age is an essential modifier of a drug efficacy, according to a recent meta-analysis. Furthermore, higher efficacy treatments exert their benefit over lower efficacy treatments only during early stages of MS, and, after age 53, the model suggests that there is no predicted benefit to receiving immunomodulatory disease-modifying therapies (DMTs) for the average MS patient. Researchers performed a literature search with pre-defined criteria and extracted relevant features from 38 clinical trials that assessed efficacy of DMTs on disability progression. They found:
- >28,000 MS subjects participating in trials of 13 categories of immunomodulatory drugs were included in the meta-analysis.
- The efficacy of immunomodulatory DMTs on MS disability strongly decreased with advancing age.
- Inclusion of baseline Expanded Disability Status Scale did not significantly improve the model.
- The regression predicts 0 efficacy beyond approximately age 53 years.
- The comparative efficacy rank derived from the regression residuals differentiates high- and low-efficacy drugs.
- High-efficacy drugs outperform low-efficacy drugs in inhibiting MS disability only for patients aged <40.5 years.
Weideman AM, Tapia-Maltos MA, Johnson K, Greenwood M, Bielekova B. Meta-analysis of the age-dependent efficacy of multiple sclerosis treatments. [Published online ahead of print November 10, 2017]. Front Neuro. doi:10.3389/fneur.2017.00577.