Real-world effectiveness of disease-modifying therapies in older adults with multiple sclerosis

Background Disease-modifying therapies (DMTs) can alter multiple sclerosis (MS) disease course.Peak prevalence age for people with MS (pwMS) has increased, but little is known about MS clinical course or DMT response in older pwMS.The objective of this retrospective analysis of a US administrative claims database to was to evaluate MS disease course, DMT use, healthcare utilisation, and time to relapse during follow-up, in pwMS ≥50 years with active disease. Methods Inclusion criteria were ≥3 years’ continuous enrolment, ≥1 MS relapse (index event), and age ≥50 years. Baseline period was 1 year prior to index event. Follow-up was 2 years.Two patient categories were considered: (i) not under DMT treatment at index date (untreated group) and (ii) under DMT treatment at index date (treated group). Results Following propensity score matching there were 3,869 patients in the treated and 3,869 patients in the untreated groups.The untreated group numerically spent more days in hospital than the treated group (9.4 vs 7.8 days) and had more emergency room (ER)/urgent care visits (1.3 vs 1.0 visits).There were no observed differences in time to relapse between groups.At index relapse, pwMS were treated with glatiramer acetate (29%), interferons (27%), oral DMTs (29%), or intravenous DMTs (15%). During follow-up, 32% of the untreated group were treated with a DMT, mostly intravenous and oral DMTs. DMT treatment remained largely unchanged in the treated group. Conclusion DMTs may provide shorter hospital stays and less frequent ER visits in older pwMS with active MS. Treatment inertia after relapse was high.