For many years, people with MS have been exhorted to commence disease-modifying drugs (DMDs) as soon as possible after diagnosis. This has been a blanket message from most major MS authorities, irrespective of demographic factors or lifestyle behaviours. OMS has argued that this needs to be tailored, and for some, may not be necessary. Unfortunately, there has been a lack of good tools to predict who will have active disease and require a drug, and who will not. In attempting to come up with such a statistical tool that could predict disease course, scientists at the National Institute of Neurological Disorders and Stroke in Bethesda, arguably one of the peak bodies for neurological research in the world, discovered something startling.
They did a meta-analysis of clinical trials that assessed how effective particular DMDs were, involving over 28,000 people with MS. Meta-analysis is a technique where researchers pool the results of all relevant, well-conducted studies, and it provides much greater statistical strength to reach conclusions about efficacy. They found that the usual MS drugs were less and less effective the older the average person with MS in the clinical trials was, to the point where, at age 53, they stopped being effective at all! They also showed that the newer generation, more potent MS drugs were more effective than that standard first generation drugs like Copaxone and interferons only for people with MS who were under 40 years old.
These surprising results give serious pause for thought. The researchers themselves say, “…in view of this meta-analysis, it should serve as a reminder that aggressive immunomodulatory DMTs may be harmful in older MS patients…”. By this they meant that not only were older people likely to experience side effects without the prospect of any benefit, but that aggressive MS drugs might also hinder the usual repair processes after nervous system damage. While the researchers were quick to point out that these conclusions apply to the “average patient”, and that some may still get some benefit after the age of 53, older people newly diagnosed with MS would be well advised to discuss the pros and cons of starting a DMD with their doctor in significant detail. Likewise, those people on a DMD who are passing this age should consider a similar conversation with their doctor. Of course, not taking a DMD does not imply no treatment; the OMS Recovery Program is a secondary preventive approach that is evidence-based and associated with good health outcomes with or without a DMD. Read the full paper here.