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Background <p>Treatment strategy for relapsing multiple sclerosis (RMS) is increasingly shifting toward first-line use of high-efficacy DMT (H-DMT). However, differences in DMT efficacy appear to decline with increasing age, and the benefit of first-line H-DMT at higher age currently remains unclear. The aim of this study was to investigate whether the superiority of H-DMT over moderate-efficacy DMT (M-DMT) decreases with age.</p> Methods <p>Using the Austrian MS database, we included previously DMT-naïve RMS patients aged ≥ 18&#xa0;years, who (i) initiated a DMT continuing it for ≥ 12&#xa0;months, (ii) had MRI at baseline, and (iii) had clinical follow-up for ≥ 24&#xa0;months. Cox regression analyses including age and DMT strategy (H-DMT vs. M-DMT) plus an interaction effect were employed to predict time to relapse.</p> Results <p>A total of 215 RMS patients (median age of 41&#xa0;years [25<sup>th</sup>–75<sup>th</sup> percentiles: 32–53], 66% females) were observed over a median of 42 (28–58) months. During this period, eighty-one (38%) patients had a relapse. While higher age was associated with decreased risk of relapse (hazard ratio (HR) 0.95 per year, 95% confidence interval [CI] 0.93–0.98, <i>p</i> &lt; 0.001), the use of H-DMT lowered the risk of relapse compared to M-DMT (HR 0.06, 95%-CI 0.01–0.45, <i>p</i> = 0.007). In patients with H-DMT, the benefit of treatment was reduced by increasing age (HR 1.06 per year, 95%-CI 1.01–1.11, <i>p</i> = 0.031). Superiority of H-DMT over M-DMT was not detectable above the age of 52&#xa0;years.</p> Conclusion <p>Efficacy of H-DMT as first-line treatment decreases with increasing age and approximates efficacy of M-DMT above 50&#xa0;years.</p>

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The role of age in choosing high-efficacy treatment for multiple sclerosis: an Austrian MS Database study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月9日

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  • Harald Hegen,
  • Fabian Föttinger,
  • Janette Walde,
  • Klaus Berek,
  • Maria Martinez-Serrat,
  • Anna Damulina,
  • Nik Krajnc,
  • Markus Ponleitner,
  • Franziska Di Pauli,
  • Christian Enzinger,
  • Florian Deisenhammer,
  • Thomas Berger,
  • Michael Khalil,
  • Gabriel Bsteh,
  • Patrick Altmann,
  • Michael Auer,
  • Klaus Berek,
  • Robert Barket,
  • Thomas Berger,
  • Gabriel Bsteh,
  • Anna Damulina,
  • Florian Deisenhammer,
  • Christian Enzinger,
  • Franziska Di Pauli,
  • Harald Hegen,
  • Bettina Heschl,
  • Michael Khalil,
  • Barbara Kornek,
  • Fritz Leutmezer,
  • Tobias Monschein,
  • Daniela Pinter,
  • Paulus Rommer,
  • Stefan Ropele,
  • Martin Schmidauer,
  • Christiane Schmied,
  • Sebastian Wurth,
  • Karin Zebenholzer,
  • Anne Zinganell,
  • Gudrun Zulehner,
  • Tobias Zrzavy

摘要

Background

Treatment strategy for relapsing multiple sclerosis (RMS) is increasingly shifting toward first-line use of high-efficacy DMT (H-DMT). However, differences in DMT efficacy appear to decline with increasing age, and the benefit of first-line H-DMT at higher age currently remains unclear. The aim of this study was to investigate whether the superiority of H-DMT over moderate-efficacy DMT (M-DMT) decreases with age.

Methods

Using the Austrian MS database, we included previously DMT-naïve RMS patients aged ≥ 18 years, who (i) initiated a DMT continuing it for ≥ 12 months, (ii) had MRI at baseline, and (iii) had clinical follow-up for ≥ 24 months. Cox regression analyses including age and DMT strategy (H-DMT vs. M-DMT) plus an interaction effect were employed to predict time to relapse.

Results

A total of 215 RMS patients (median age of 41 years [25th–75th percentiles: 32–53], 66% females) were observed over a median of 42 (28–58) months. During this period, eighty-one (38%) patients had a relapse. While higher age was associated with decreased risk of relapse (hazard ratio (HR) 0.95 per year, 95% confidence interval [CI] 0.93–0.98, p < 0.001), the use of H-DMT lowered the risk of relapse compared to M-DMT (HR 0.06, 95%-CI 0.01–0.45, p = 0.007). In patients with H-DMT, the benefit of treatment was reduced by increasing age (HR 1.06 per year, 95%-CI 1.01–1.11, p = 0.031). Superiority of H-DMT over M-DMT was not detectable above the age of 52 years.

Conclusion

Efficacy of H-DMT as first-line treatment decreases with increasing age and approximates efficacy of M-DMT above 50 years.