Abstract：
BACKGROUND: There is a lack of knowledge of disease course, prognosis, comorbidities and potential treatments of elderly MS patients.
OBJECTIVE: To characterize the disease course including disability progression and relapses, to quantify the use of DMTs and to identify comorbidities and risk factors for progression in elderly multiple sclerosis (MS) patients.
METHODS: This is a retrospective study of 1200 Austrian MS patients older than 55 years as of May 1st, 2017 representing roughly one-third of all the MS patients of this age in Austria. Data were collected from 15 MS centers including demographics, first symptom at onset, number of relapses, evolvement of disability, medication, and comorbidities.
RESULTS: Median observation time was 17.1 years with 957 (80%) relapsing and 243 (20%) progressive onsets. Average age at diagnosis was 45 years with a female predominance of 71%. Three-hundred and twenty-six (27%) patients were never treated with a DMT, while most treated patients received interferons (496; 41%) at some point. At last follow-up, 420 (35%) patients were still treated with a DMT. No difference was found between treated and never-treated patients in terms of clinical outcome; however, patients with worse disability progression had significantly more DMT switches. Pyramidal onset, number of comorbidities, dementia, epilepsy, and psychiatric conditions as well as a higher number of relapses were associated with worse outcome. The risk of reaching EDSS 6 rose with every additional comorbidity by 22%. In late and very-late-onset MS (LOMS, VLOMS) time to diagnosis took nearly twice the time compared to adult and early onset (AEOMS). The overall annualized relapse rate (ARR) decreased over time and patients with AEOMS had significantly higher ARR compared to LOMS and VLOMS. Four percent of MS patients had five medications or more fulfilling criteria of polypharmacy and 20% of psychiatric drugs were administered without a matching diagnosis.
CONCLUSIONS: In this study, we identified number of comorbidities, pyramidal and cerebellar signs, and a higher number of relapses as unfavorable prognostic factors in elderly MS patients filling gaps of knowledge in patients usually underrepresented in clinical trials and may guide future therapeutic studies.
OBJECTIVE: To characterize the disease course including disability progression and relapses, to quantify the use of DMTs and to identify comorbidities and risk factors for progression in elderly multiple sclerosis (MS) patients.
METHODS: This is a retrospective study of 1200 Austrian MS patients older than 55 years as of May 1st, 2017 representing roughly one-third of all the MS patients of this age in Austria. Data were collected from 15 MS centers including demographics, first symptom at onset, number of relapses, evolvement of disability, medication, and comorbidities.
RESULTS: Median observation time was 17.1 years with 957 (80%) relapsing and 243 (20%) progressive onsets. Average age at diagnosis was 45 years with a female predominance of 71%. Three-hundred and twenty-six (27%) patients were never treated with a DMT, while most treated patients received interferons (496; 41%) at some point. At last follow-up, 420 (35%) patients were still treated with a DMT. No difference was found between treated and never-treated patients in terms of clinical outcome; however, patients with worse disability progression had significantly more DMT switches. Pyramidal onset, number of comorbidities, dementia, epilepsy, and psychiatric conditions as well as a higher number of relapses were associated with worse outcome. The risk of reaching EDSS 6 rose with every additional comorbidity by 22%. In late and very-late-onset MS (LOMS, VLOMS) time to diagnosis took nearly twice the time compared to adult and early onset (AEOMS). The overall annualized relapse rate (ARR) decreased over time and patients with AEOMS had significantly higher ARR compared to LOMS and VLOMS. Four percent of MS patients had five medications or more fulfilling criteria of polypharmacy and 20% of psychiatric drugs were administered without a matching diagnosis.
CONCLUSIONS: In this study, we identified number of comorbidities, pyramidal and cerebellar signs, and a higher number of relapses as unfavorable prognostic factors in elderly MS patients filling gaps of knowledge in patients usually underrepresented in clinical trials and may guide future therapeutic studies.
摘要：
背景：缺乏对病程的了解，预后,老年MS患者的合并症和潜在治疗方法。
目的：为了表征疾病的病程，包括残疾进展和复发，量化DMT的使用，并确定老年多发性硬化症（MS）患者的合并症和进展的危险因素。
方法：这是一项截至5月1日的1200名55岁以上的奥地利MS患者的回顾性研究，2017年约占奥地利该年龄MS患者的三分之一。数据来自15个MS中心，包括人口统计学，发病时的第一个症状，复发的次数，残疾的演变，药物,和合并症。
结果：中位观察时间为17.1年，其中957例（80％）复发，243例（20％）进展性发作。诊断时的平均年龄为45岁，女性占71％。三百二十六（27％）患者从未接受过DMT治疗，而大多数接受治疗的患者在某个时间点接受干扰素（496；41％）。在最后的随访中，420（35％）患者仍接受DMT治疗。在临床结果方面，没有发现治疗和从未治疗的患者之间的差异;然而，残疾进展更差的患者的DMT转换明显更多.锥体发作，合并症的数量，痴呆症,癫痫,精神疾病以及较高的复发次数与较差的结局相关。每增加一次合并症，达到EDSS6的风险就会增加22％。在晚期和非常晚期的MS(LOMS，VLOMS）诊断时间几乎是成人和早发性（AEOMS）的两倍。总体年复发率（ARR）随着时间的推移而下降，与LOMS和VLOMS相比，AEOMS患者的ARR明显更高。4%的MS患者有五种或更多的药物符合多重用药标准，20%的精神科药物在没有匹配诊断的情况下给药。
结论：在这项研究中，我们确定了合并症的数量，锥体和小脑的迹象，老年MS患者中更多的复发作为不良预后因素，填补了临床试验中通常代表性不足的患者的知识空白，并可能指导未来的治疗研究。
目的：为了表征疾病的病程，包括残疾进展和复发，量化DMT的使用，并确定老年多发性硬化症（MS）患者的合并症和进展的危险因素。
方法：这是一项截至5月1日的1200名55岁以上的奥地利MS患者的回顾性研究，2017年约占奥地利该年龄MS患者的三分之一。数据来自15个MS中心，包括人口统计学，发病时的第一个症状，复发的次数，残疾的演变，药物,和合并症。
结果：中位观察时间为17.1年，其中957例（80％）复发，243例（20％）进展性发作。诊断时的平均年龄为45岁，女性占71％。三百二十六（27％）患者从未接受过DMT治疗，而大多数接受治疗的患者在某个时间点接受干扰素（496；41％）。在最后的随访中，420（35％）患者仍接受DMT治疗。在临床结果方面，没有发现治疗和从未治疗的患者之间的差异;然而，残疾进展更差的患者的DMT转换明显更多.锥体发作，合并症的数量，痴呆症,癫痫,精神疾病以及较高的复发次数与较差的结局相关。每增加一次合并症，达到EDSS6的风险就会增加22％。在晚期和非常晚期的MS(LOMS，VLOMS）诊断时间几乎是成人和早发性（AEOMS）的两倍。总体年复发率（ARR）随着时间的推移而下降，与LOMS和VLOMS相比，AEOMS患者的ARR明显更高。4%的MS患者有五种或更多的药物符合多重用药标准，20%的精神科药物在没有匹配诊断的情况下给药。
结论：在这项研究中，我们确定了合并症的数量，锥体和小脑的迹象，老年MS患者中更多的复发作为不良预后因素，填补了临床试验中通常代表性不足的患者的知识空白，并可能指导未来的治疗研究。
