Aging in multiple sclerosis

The factor that is most relevant and strongly associated with the clinical course of multiple sclerosis is chronological age. Very young patients almost exclusively have relapsing remitting disease, whereas those with later onset disease face a more rapid development of permanent disability.

There is substantial epidemiological, pathological, and clinical evidence that age contributes to how the disease is experienced by patients living with multiple sclerosis.

For people with progressive multiple sclerosis, the poor response to current disease modifying therapies might be related to ageing in the immune system and CNS.

Drug development and trial design should consider the impact of senescence on multiple sclerosis pathophysiology and on the risk of side-effects.

Ageing is also associated with increased risks of side-effects caused by some multiple sclerosis therapies.

Understanding the role of ageing in immune and neural cell function in patients with multiple sclerosis might be key to halting non-relapse-related progression.

The growing literature on potential therapies that target senescent cells and ageing processes might provide effective strategies for remyelination and neuroprotection.

Clinical trials need to start including older individuals to understand the efficacy and safety of novel agents in those ageing with multiple sclerosis.

Lastly, senolytic or senomorphic therapies, which remove or modulate the function of senescent cells, that are already in development for other ageing-related diseases could hold promise for future applications in multiple sclerosis.

Source: Lancet Neurol 2022