The role of age in choosing high-efficacy treatment for multiple sclerosis: an Austrian MS Database study

Abstract Background Treatment strategy for relapsing multiple sclerosis (RMS) is increasingly shifting towards first-line use of high-efficacy DMT (H-DMT). However, DMT efficacy declines with increasing age and the benefit of first line H-DMT at higher age remains unclear. Here, we aimed to investigate whether the superiority of H-DMT over moderate-efficacy DMT (M-DMT) depends on age. Methods Using the Austrian MS database, we included previously DMT-naïve RMS patients aged ≥18 years, who i) initiated a DMT continuing it for ≥12 months, ii) had MRI at baseline, and iii) had clinical follow-up for ≥24 months. Cox regression analyses including age and DMT strategy (H-DMT vs. M-DMT) plus an interaction effect were employed to predict time to relapse. Results A total of 215 RMS patients (median age of 41 years [25 th -75 th percentiles: 32-53], 66% females) were observed over a median of 42 (28-58) months. During this period, eighty-one (38%) patients had a relapse. While increasing age was associated with decreased risk of relapse (hazard ratio (HR) 0.95 per year, 95% confidence interval [CI]: 0.93-0.98, p