DMDs not effective for the average person with MS aged 53 or more: major study finds

November 14, 2017

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.

14 thoughts on ‘DMDs not effective for the average person with MS aged 53 or more: major study finds

  1. Dx in 2010, but optic neuritis issue was experienced in 1981. Took rebif 04/2010 till 11/2012….aubagio for 5 months in 2015. Took gilenya 06/1017-10/2017….so glad to see this article. I have endured the most pain in the last three months than any time with ms…finally told I am now secondary progressive m.s.,which I believe is just a blanket thing…yes my walking is more cumbersome. Dr. Wants me to go on cop axons..even though it’s less effective. Ugh…even the a bit suspicious…I have a rheumatologist appointment in February…but I also have RA in my family…

  2. I have just had 2 infusions of ocrevus. I am 77 years old and have had MS for 53 years. The disease has been progressing slowly. I have been on a variety of MS meds. I have also initiated an intensive exercise program when the disease started. I ran over 50 thousand miles when I was able to run. I haven’t run in the last ten years due to the progression but I lift weights, twenty minutes on the elliptical machine and cycle machine. I don’t know if the exercise or medication has been the factor slowing the progression of if the disease is just following it’s own natural process.

  3. Once again George Jelinek – you have provided some excellent, evidence based information that we can add to our MS tool bags. Thank you!!

  4. The authors said two other things that are worth emphasizing. First, they mention that older individuals that still experience relapses may benefit from DMTs. Second, they suggest that younger MS patients may want to opt for higher efficacy DMTs at a young age, when these are most effective.

  5. I have restarted Copaxone in July 2017, after being on Tysabri for 9 months, which I ended up getting the JCV virus, but on a small scale. This did nothing for me, and felt no difference. Neurologist discussed going onto Ocrevus, but I have chosen not to try this drug. I have been following the OMS Recovery Program since October 2013, but not quite 100%, just find doing the meditating and keeping my mind quiet, somewhat of a challenge.

  6. I’m 50yo, dx 3.5 years ago, symptoms for 12 years prior. Have opted to be drug free. So far so good 🙂
    Fingers crossed it continues.

  7. I find this very interesting. I am a 50 year old female and was diagnosed 2.5 years ago, no mention of alternative medicine, walked into the the hospital fine after 3 months from my attack. Then advised strongly to go onto a DMD Plegridy was selected! Done it for 1 .5 years and since then have never had a pain free day or being able to walk any distance since. It was like radiation being pumped round my body, every time injected – but hey that natural supposedly? advised by my MS nurse. 2 weekends out of a month in my bed after each injection? Argued with my MS nurse every 3 months but she refused to change my meds? Got to a stage I insisted now on Tecfidera only 3 weeks, cannot see any difference, only not taking to my bed for the weekends. It has been advised that I have a very low scale MS with no active liaisons, and this has been my 1st every attack. So really do not know what to do? NHS say DMD drugs, then their is change your lifestyle that my MS nurse advises against as there is no medical facts? don’t take the drugs. Its just sooo confusing. So 2018 start the Terry Wahl plan, bought and exercise bike, and if I am still in pain after all of this I believe after reading this article the drugs will be stopped.
    Roving and get back my health. No more DMD for me.

    • Hi Amanda, thanks so much for your message. We understand that there is a lot of conflicting information out there and that this can be confusing. Luckily, following a healthy lifestyle will benefit you regardless of whether you are on medication or not. The OMS Recovery Program is an evidence-based 7-step program that has been shown to improve MS symptoms. It involves following a plant-based diet with fish, exercising regularly, taking vitamin D supplements and meditating. You can find more information on our website here: Kind regards, OMS team.

  8. You may want to investigate the Coimbra Protocol of ultra high Vitamin D3. It has been successful in stopping progression for 1000s of people.. BUT it requires medical oversight by a doctor familiar with it since various test are needed regularly to monitor your health. I started it after having MS for 10 years and my progression has stopped AND my disability is slowly improving. Wish I had found out about it sooner. Good Luck !

  9. Was diagnosed Aug 17 after 2nd episode of optic neuritis, 1st being 10 years before. I get pains in my arm and hand and burning/tingly feet but nothing major. Was waiting 5 months to start copaxone and wishing I knew then what I know now as would not of bothered. U put your trust is ur doctors and nurses that they know best but not always. I turned 39 in December so chances are a year down the line it won’t be effective. I’m certainly not going on anything stronger as the pain effect seem worse than my MS symptoms!! I’ve started a Healthy diet, exercise, vitamins, avoiding stress, trying to meditate along with oxygen therapy and counseling at my local MS therapy centre and feeling really good mentally and physically. So is there any point in carrying on?

  10. I have had problem with DMD long before I was 55. My bad reactions caused me to quit when I was 40 – 25 years ago. I see their are studies that say they are not that helpful. If the work for you the go for it.

  11. Caught in passing, McDougall (on , a webinar that touches on osteoporosis) mentions that the average cost of drugs for PwMS being from $75,000 to $85,000 pa. What proportion of that is for patients aged over 50. Can’t imagine how that happens, but presumably based on the expectation that medical professionals know best. Even if that were so, looking after ourselves seems a priority, especially as we can do something about it all day, every day.

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