Author Topic: (AAN abst.) Study shows no benefit from DMT for MS patients beyond age 53  (Read 45 times)

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Offline agate

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Presented in a platform session of the annual AAN meeting (Los Angeles, April 27, 2018):
Quote
Meta-Analysis of the Age-Dependent Efficacy of Multiple Sclerosis Treatments


Ann Marie Weideman1 , Marco Tapia-Maltos1,2, Kory Johnson3 , Mark Greenwood4 , Bibiana Bielekova1


1 Neuroimmunological Diseases Unit/NINDS/NIH, 2 PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, 3 Bioinformatics Section/NINDS/NIH, 4 Department of Mathematical Sciences, Montana State University


Objective:


To investigate the hypothesis that the efficacy of immunomodulatory disease-modifying therapies (DMTs) is dependent on age in patients with multiple sclerosis (MS). Background: As new therapies are approved for the treatment of MS, it becomes more difficult to select the treatment option that will best limit progression of the disease.


Design/Methods:


We performed a meta-analysis of blinded, randomized clinical trials involving 28,000 patients with MS and identified 38 clinical trials that reported EDSS outcomes on disability progression. We fit a linear regression, weighted for sample size and trial duration, to FDA-approved drugs (in approved indications) from these trials and calculated the mean of the weighted residuals for each drug type. The sign, positive or negative, of this mean was used to classify the drugs as low- or high-efficacy. We then refit the regression (using a stepdown testing procedure) by including possible interactions between age, efficacy classification, and baseline EDSS.


Results:


The model fit improved significantly by including the interaction between age and efficacy classification. The resulting model predicted a strong decline in therapeutic efficacy (R2 = 0.6757, p = 6.39e-09) until age 53 years, at which point there was no predicted benefit to receiving DMT.


Furthermore, high-efficacy therapy was more beneficial than low-efficacy therapy only in patients younger than 40.5 years.


Conclusions:


The data derived from this meta-analysis demonstrate that there is a significant decrease in the efficacy of immunomodulatory DMTs with age. The model results are derived from regressions representing the disability progression of an average patient on an average DMT. This progression can be reduced by administering high-efficacy therapy during early stages of the disease, and, for patients over the age of 53 years, progression is unaffected by immunomodulatory DMTs.


Study Supported by:


The study was supported by the intramural research program of the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH).
« Last Edit: April 29, 2018, 09:39:04 pm by agate »
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