Introduction
Epidemiology of MS in the older age group
Age-related immunosenescence in MS
Disease behavior in older adults with MS
Diagnosis
Disease therapy in older adults with MS
Role of comorbidities to guide treatment selection
DMT | Comorbidities that need to be considered |
---|---|
Interferon beta | Spasticity, depression, suicidality, seizures, headaches, congestive heart failure, pulmonary hypertension [54] |
Glatiramer acetate | No major impact on pre-existing comorbidities known [55] |
Teriflunomide | Hypertension, peripheral neuropathy, renal failure, hyperkalemia, contraindication in severe hepatic impairment, pregnancy [56] |
Sphingosine 1-phosphate receptor modulators | Hypertension, headaches, macular edema, bradyarrhythmia, restrictive lung disease, contraindication in severe untreated obstructive sleep apnea, second/third degree atrioventricular block (without a pacemaker, and if myocardial infarction, unstable angina, stroke, transient ischemic attack, or decompensated heart failure has occurred in past 6 months), concurrent use with monoamine oxidase inhibitor in ozanimod, CYP2C9*3/*3 genotype in siponimod [57‐59] |
Fumarates | Dyspepsia, irritable bowel syndrome, inflammatory bowel disease, preexisting liver injury [60] |
B-cell depleting therapies | Colitis, hypogammaglobulinemia, contraindication in active hepatitis B infection [61] |
Natalizumab | No major impact on pre-existing comorbidities known, contraindication if history of progressive multifocal leukoencephalopathy [62] |
Cladribine | No major impact on pre-existing comorbidities known, contraindication in chronic infections such as HIV, hepatitis, tuberculosis, pregnancy, active malignancy, and patients still of reproductive potential who do not plan to use effective contraception [63] |
Alemtuzumab | Elevated liver function tests, contraindication in HIV or other active infection [64] |