A new meta-analysis study reveals that the ability of MS drugs to slow disability progression strongly decreases as a patient ages.
There are currently 16 disease modifying therapies (DMTs) approved by the U.S. Food and Drug Administration to treat multiple sclerosis (MS). With that many from which to choose, how does a person with MS know which will work best for them? A new report leads us to understand how a patient’s age might affect MS drug efficacy.
The study, published in Frontiers in Neurology, was not a drug trial itself, rather it was a meta-analysis of extracted mean data from 38 published clinical trials studying 13 of those approved drugs. This data is then applied to a statistical model (called linear regression) in order to corelate MS drug efficacy and the age of patients.
Meta-analysis “is the statistical procedure for combining data from multiple studies. When the treatment effect (or effect size) is consistent from one study to the next, meta-analysis can be used to identify this common effect. When the effect varies from one study to the next, meta-analysis may be used to identify the reason for the variation,” according to Comprehensive Meta-Analasis.
This analysis aimed to determine how well the drugs worked were measured by their ability to prevent disability progression compared with placebo (or against interferon-beta preparations in trials using them as active comparators). Data from 28,000 people in various drug trials were analyzed.
It is very important to understand, if one were to use this study as a tool in deciding on a DMT for themselves, that the data is average and not used under current prescribing guidelines.
In general, the researchers noted that no matter a person’s level of disability at the beginning of the drug trial, a DMT’s ability to slow disability progression strongly decreased with the advancing age of the patient. And, while only predictive, they found zero efficacy of drugs beyond the approximate age 53 years.
As they evaluated meds, researchers were able to differentiate between high- and low-efficacy drugs. Even the best-performing MS meds appear to stop out-performing the lower-efficacy drugs around the age of 40 ½.
This information is sure to be fodder for conversation between middle-aged people with MS and their medical professionals at their next appointments. Particularly when the researchers say: “A prescribing clinician must consider the possibility that starting or continuing immunomodulatory DMT beyond age 53 will expose an average patient to treatment-associated risks with few, if any, potential benefits.”
Further mining of data revealed evidence that progressive MS is simply a later stage of the MS disease process, and not a different condition, as sometimes thought.
So what about the terms “high-efficacy” and “low-efficacy” when talking about these drugs. Why would one want to be on a treatment deemed to have low efficacy? These terms are a derivation of weighted standardized residuals — a method of analyzing statistics — and not, necessarily, a clinical judgement as to how effective the medication is for its approved purpose.
Limitations abound in the approach to modeling used in this study. Only one trial reviewed, for example, had a mean participant age over 50 years. As stated previously, these are only average findings. Any one individual’s experience on a DMT will vary based on a number of factors beyond age.
Nonetheless, people advancing toward those ages identified in the study should be informed of the findings and discuss them with their MS specialist.
As with many other studies, the authors of this paper reiterate the importance of early treatment upon MS diagnosis to prevent disability. The authors concluded, “Delaying any DMT, even for a few years, leads to a decrease in cumulative efficacy that cannot be easily regained by opting for more aggressive treatments at a later age.”
So, as more treatments in number and better treatments in efficacy are developed for people with MS, and treatment regimens at the point of diagnosis and early in the disease are becoming clearer, this new review may beg the question of what to do as people with MS age.
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Trevis L. Gleason is an award-winning author, chef and blogger who was diagnosed with multiple sclerosis in 2001. He lives in Seattle, Washington and County Kerry Ireland with his wife Caryn and their Wheaten Terriers, Sadie and Maggie. His website is trevislgleason.com. Trevis’ book, Chef Interrupted, is available on Amazon. Follow him on the Life With MS Facebook page and on Twitter.