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

Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.

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Copyright © 2024 Fernández, Sörensen, Comi, Vermersch, Hartung, Leocani, Berger, Van Wijmeersch and Oreja-Guevara.

Déclaration de conflit d'intérêts

Author OF received speaking and/or consulting fees from Allergan, Almirall, Bayer Schering, Biogen, Merck Serono, Novartis, Sanofi, and Teva; compensation for serving as a journal editor, associate editor, or member of an editorial advisory board Revista Española de Esclerosis Múltiple; and research support from Hospital Foundation FIMABIS. Author GC received consulting fees from Actelion, Bayer Schering, Merck Serono, Novartis, Sanofi, and Teva and lecture fees from Bayer Schering, Biogen Dompé, Merck Serono, Novartis, Sanofi, Serono, Symposia International Foundation, and Teva. Author PV has received honoraria and contributions for attending meetings from Biogen, Sanofi-Genzyme, Novartis, Teva, Merck, Roche, Imcyse, AB Science, Janssen, and BMS-Celgene. The author’s research has been supported by grants from Novartis, Sanofi-Genzyme, and Merck. Author H-PH received honoraria for serving on steering, data monitoring or scientific advisory boards from Aurinia Pharma, BMS Celgene, Boehringer Ingelheim, Horizon Therapeutics, Merck, Novartis, Roche, TG Therapeutics. Author BVW has received advisory board and/or speaking fees from Almirall, Biogen, Merck, Novartis, Roche, and Sanofi; research support from Biogen, Merck, Novartis, and Sanofi, and contracted research from Biogen, Merck, Sanofi, Novartis, and Roche. Author PS has received personal compensation for consultations, serving on scientific advisory boards, steering committees, independent data monitoring committees or has received honoraria as speaker from Biogen, Merck, Novartis, TEVA, GlaxoSmithKline, SanofiAventis/Genzyme, and BMS/Celgene. Author TB has participated in meetings sponsored by and received honoraria lectures, advisory boards, consultations from pharmaceutical companies marketing treatments for multiple sclerosis: Almirall, Bayer, Biogen, Biologix, Bionorica, Bristol-Myers-Squibb, Eisai, GW Pharma, Horizon, Janssen-Cilag, MedDay, Merck, Novartis, Octapharma, Roche, Sandoz, Sanofi/Genzyme, TG Pharmaceuticals, TEVA-ratiopharm and UCB. His institution has received financial support in the last 12 months by unrestricted research grants Biogen, Bayer, Bristol-Myers-Squibb, Merck, Novartis, Roche, Sanofi/Genzyme, and TEVA ratiopharm and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Bayer, Biogen, Bristol-Myers-Squibb, Merck, Novartis, Octapharma, Roche, Sanofi/Genzyme, and TEVA. Author CO-G has received speaking and consulting honoraria from Biogen, BMS, Merck, Novartis, Sanofi, Janssen, and Roche. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decisions.