Multiple sclerosis in older adults: the clinical profile and impact of interferon beta treatment

Background. We examined (1) patient characteristics and disease-modifying drug (DMD) exposure in late-onset (LOMS, >= 50 years at symptom onset) versus adult-onset (AOMS, 18-<50 years) MS and (2) the association between interferon-beta (IFN beta) and disability progression in older relapsing-onset MS adults (>= 50 years). Methods. This retrospective study (1980-2004, British Columbia, Canada) included 358 LOMS and 5627 AOMS patients. IFN beta-treated relapsing-onset MS patients aged >= 50 (regardless of onset age, 90) were compared with 171 contemporary and 106 historical controls. Times to EDSS 6 from onset and from IFN beta eligibility were examined using survival analyses. Results. LOMS patients (6%) were more likely to be male, with motor onset and a primary-progressive course, and exhibit faster progression and were less likely to take DMDs. Nonetheless, 57% were relapsing-onset, of which 31% were prescribed DMDs, most commonly IFN beta. Among older relapsing-onset MS adults, no significant association between IFN beta exposure and disability progression was found when either the contemporary (hazard ratio [HR]: 0.46; 95% CI: 0.18-1.22) or historical controls (HR: 0.54; 95% CI: 0.20-1.42) were considered. Conclusion. LOMS differed clinically from AOMS. One-third of older relapsing-onset MS patients were prescribed a DMD. IFN beta exposure was not significantly associated with reduced disability in older MS patients.