ECTRIMS Congress 2021: Updates in MS - Episode 4
Le Hua, MD, provided insight on the current knowns and unknowns about older patients with multiple sclerosis, how their disease progresses, and the need for additional research.
Le Hua, MD: We know a lot about older patients and we’re starting to just scratch the surface. Because we have a lot of therapies that do a significant job of stopping relapses, which is the part of the disease we know we control well. However, we still see disability progression. Now we’re starting to coin the phrase progression independent of relapse activity, or PURA.
Because we’re seeing PURA, we still want to get a better understanding of what drives that process. Aging is part of that, immunosenescence is part of that, different changes happening in the brain, different aging processes, reduced ability to remyelinate, reduced ability to utilize energy, clear debris, and help with oxygenation species are all part of that change in older patients.
On the flip side, because of immunosenescence, safety also becomes a concern for older patients, particularly because of increased infection risks. Knowing all that, we need to start to approach our older patients differently. One of the unfortunate things we don’t have is that most trials have not enrolled older patients. Without enrollment of older patients, we don’t have high quality, prospective data. In terms of efficacy and safety, we’re doing the best we can with retrospective data, large control studies, and subgroup analyses, but formal studies in older patients is what’s needed. As we better understand the underlying disease processes and safety concerns, we can then better design drugs to drive at slowing down progression and disability in MS.