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    Interesting article on age and DMDs

    Thank to Temagami for this link. I haven't gotten to the original article yet but this synopsis was interesting and seems to indicate the results from a meta analysis downplayed the efficacy of medications, even the newer meds, in older people with MS, on average.

    My MS specialist actually said something about considering no meds at my last appointment due to being "stable" for so long and I thought he lost his mind, especially for the next 8 or so years while I'd like to continue working if I'm able.

    Have you heard this before? Any insights/opinions?

    "Specifically, the model predicted that on average DMTs cease to be effective beyond the age of approximately 53 years. When the low- and high-efficacy DMTs were modelled separately, the high-efficacy drugs were more effective than low-efficacy drugs only when used in people of 40.5 years or younger; after this point there was no benefit in the average person with MS using high-efficacy drugs. The authors highlighted that the continuous loss of efficacy with age reported in this study supports the notion that “progressive MS is simply a later stage of the MS disease process”."

    From:
    https://www.msbrainhealth.org/treatm...-linked-to-age
    He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true to the last beat of his heart. You owe it to him to be worthy of such devotion.
    Anonymous

    #2
    Originally posted by Jules A View Post
    Thank to Temagami for this link. I haven't gotten to the original article yet but this synopsis was interesting and seems to indicate the results from a meta analysis downplayed the efficacy of medications, even the newer meds, in older people with MS, on average.

    My MS specialist actually said something about considering no meds at my last appointment due to being "stable" for so long and I thought he lost his mind, especially for the next 8 or so years while I'd like to continue working if I'm able.

    Have you heard this before? Any insights/opinions?

    "Specifically, the model predicted that on average DMTs cease to be effective beyond the age of approximately 53 years. When the low- and high-efficacy DMTs were modelled separately, the high-efficacy drugs were more effective than low-efficacy drugs only when used in people of 40.5 years or younger; after this point there was no benefit in the average person with MS using high-efficacy drugs. The authors highlighted that the continuous loss of efficacy with age reported in this study supports the notion that “progressive MS is simply a later stage of the MS disease process”."

    From:
    https://www.msbrainhealth.org/treatm...-linked-to-age
    Jules ~

    I never thought about the age factor as much as the inflammatory stage vs neurodegenerative (progressive) stage.

    The belief has been that the DMT's are effective against inflammation, but not so much for neurodegeneration.

    I suppose inflammation decreases with age?

    Take Care
    PPMS for 26 years (dx 1998)
    ~ Worrying will not take away tomorrow's troubles ~ But it will take away today's peace. ~

    Comment


      #3
      Originally posted by KoKo View Post
      I suppose inflammation decreases with age?
      It seems perhaps the ability to keep up the inflammatory cascade wears down as we age? Which would make sense simply based on the old predictions of how many of us starting with RRMS end up SPMS.

      Everything slows down and gets faulty as we age I suppose. Reflexes slow, metabolism tanks, the ability to fight infection, skin loses collagen, new onset hypertension, hyperlipidemia, eczema...
      He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true to the last beat of his heart. You owe it to him to be worthy of such devotion.
      Anonymous

      Comment


        #4
        I have this as a topic to discuss with neuro in June.

        I guess the one question I have is based on the age of some of the newer drugs related to when someone diagnosed and delay to treatment. So how many may actually be SPMS and in study? Especially for the 40+ age group. So inflammatory versus progressive.

        Since 55, I have asked before about it, especially since I have had it at least 13 years before diagnosis and started on interferons. But since I was progressing before Tysabri and stabilized after I went on it, I wasn't ready to pull the plug.

        I believe there are additional active studies on whether MS "burns out". Plus I think there was a recent study that showed delay to SPMS for Tysabri and other newer drugs. It is so confusing...have to get my research hat on before June.
        Kathy
        DX 01/06, currently on Tysabri

        Comment


          #5
          I tried it, here's what happened ...

          Don't do it, Jules.

          I went 6 years with no MRI activity while taking Copaxone. Such a weak drug. Already 56 years old. What could go wrong?

          After a year of being DMT free, I got an MRI a couple weeks ago. The result? Four new lesions, including one on my brainstem.

          I feel like an idiot.

          (Note, this is the MRI where we measured my brain atrophy, and I'll be going on a new and more brain-saving therapy in the next few weeks. Meanwhile, I'm terrified that my MS might attack something that can't be reversed while I wait to start Ocrevus.)

          Bottom line--I took on new brain damage, so you don't have to. Stay on your med. The doctors are wrong. So help me, I know.

          Comment


            #6
            Kathy I will poke around and see what I can find. This will be an important area to stay on top of the current research for us both. Great news that Tysabri has worked so well for you.

            Mable thank you for sharing your experience. I definitely have no plans to stop medication while I"m still working. Like you were I'm on Copaxone and have asked about starting a newer medication but my neurologist didn't want to change what has seemed to work so well. I also haven't seen any recommendations to change unless a treatment failure which in my case Copaxone can't be considered, yet, of course which seems to always be the caveat with MS.
            He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true to the last beat of his heart. You owe it to him to be worthy of such devotion.
            Anonymous

            Comment


              #7
              Well, that's cheery. And true. 😂

              Originally posted by Jules A View Post
              Everything slows down and gets faulty as we age I suppose. Reflexes slow, metabolism tanks, the ability to fight infection, skin loses collagen, new onset hypertension, hyperlipidemia, eczema...

              Comment


                #8
                Originally posted by Mable View Post
                Don't do it, Jules.

                I went 6 years with no MRI activity while taking Copaxone. Such a weak drug. Already 56 years old. What could go wrong?

                After a year of being DMT free, I got an MRI a couple weeks ago. The result? Four new lesions, including one on my brainstem.

                I feel like an idiot.
                Thanks for sharing your experience.

                I'm 56, no flares for 8 years. Moving into SPMS. Also on copaxone.

                I've wondered when the most appropriate time to go off might be. I guess I won't be in a hurry.
                ~ Faith
                MSWorld Volunteer -- Moderator since JUN2012
                (now a Mimibug)

                Symptoms began in JAN02
                - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
                - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
                .

                - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
                - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

                Comment


                  #9
                  I question the idea of going off DMTs as one ages because most clinical trials won´t allow people over 55. I think that they just don´t have the data since for some bizarre reason they won´t include mature folks in the trials. Maybe they figure that there are too many co-morbidities and it muddies the data pool. Until they do trials, and would it even be ethical to ask someone to discontinue, I stay on something. The crazy thing is that if they did have data showing benefit, they could keep "customers" for years and years.

                  For me, a DMT didn´t even start to work until I hit 55 as I failed C. and G.

                  Comment


                    #10
                    Originally posted by Temagami View Post
                    I question the idea of going off DMTs as one ages because most clinical trials won´t allow people over 55. I think that they just don´t have the data since for some bizarre reason they won´t include mature folks in the trials. Maybe they figure that there are too many co-morbidities and it muddies the data pool. Until they do trials, and would it even be ethical to ask someone to discontinue, I stay on something. The crazy thing is that if they did have data showing benefit, they could keep "customers" for years and years.

                    For me, a DMT didn´t even start to work until I hit 55 as I failed C. and G.
                    I hear ya and agree at least for now but check out the article. It seems in indicate fairly solid data with a significant number of trials reviewed.

                    As for customers the supposed beauty of research is that it is unbiased so theoretically the authors should have no interest in keeping us on meds if not needed.
                    He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true to the last beat of his heart. You owe it to him to be worthy of such devotion.
                    Anonymous

                    Comment


                      #11
                      Jules,
                      I've seen this article before and I believe it has a number of serious shortcomings.

                      First off, I didn't see anywhere in the study where they accounted for increasing disability due strictly to ageing and it seems to be a huge stretch to blame all of the increase of disability on efficacy of the DMT alone. Secondly, if you read the entire study, they admit to having made an awful lot of assumptions many of which are questionable. Thirdly, the linear regression model they use does not seem to fit their data very well. And fourthly, to say that "on average DMT's cease to be effective beyond the age of 53 years" is a grossly misleading generalization.

                      While the efficacy of a given DMT may well vary with age, the effectiveness of certain drugs still stands out on the scattergram. Ocrelizumab, Rituximab, Siponimab, and Glatiramer Acetate are all above the mean linear regression line at advancing age.

                      I, personally, am well into SP, I use Rituxan and plan to stay on it as the effect on the onset of my secondary progression was quite noticeable. Currently, I try to base effectiveness more on brain volume than other measurements.

                      I hope you will respond after you have read the study itself, I value your opinion.

                      Bottom line, I wouldn't give up based on this particular study.

                      Comment


                        #12
                        Badaimata - thanks. I read the original last night, but want to go back and re-read. I picked up on some of what you stated. I found interesting their take on disease phase labels and relation to inflammation - different than how it is managed today.

                        I also want to take a look at how funded. I had my infusion yesterday, so still in a little no energy mode. I always add a little more skepticism when funded in part by any for profit company, whether pharmaceurical, insurance, etc...

                        Studies like this one sometimes make me worry how an insurance company might use it to try and deny coverage for meds. So I am glad they did add some blurbs about individual responses can be different.
                        Kathy
                        DX 01/06, currently on Tysabri

                        Comment


                          #13
                          Study at University of Colorado

                          Yes, Dr Vollmer at Univ of CO mentioned this to me years ago. In fact, Dr Corboy is leading this study. Last year or so I called to see if I could join (I am now 57 yrs old) but the only way to join was to be on a DMT and I was moving off Copaxone due to injection site issues. Thus, yes...I wonder if it is worth the risk of “other” complications getting back on a DMT. This decision part of MS is so hard to know what is best or right to do.

                          Check out the link: https://clinicaltrials.gov/ct2/show/NCT03073603

                          Comment


                            #14
                            Originally posted by pennstater View Post
                            Badaimata - thanks. I read the original last night, but want to go back and re-read. I picked up on some of what you stated. I found interesting their take on disease phase labels and relation to inflammation - different than how it is managed today.

                            I also want to take a look at how funded. I had my infusion yesterday, so still in a little no energy mode. I always add a little more skepticism when funded in part by any for profit company, whether pharmaceurical, insurance, etc...

                            Studies like this one sometimes make me worry how an insurance company might use it to try and deny coverage for meds. So I am glad they did add some blurbs about individual responses can be different.
                            Kathy,
                            Yes, also, although it was a few months ago that I read the study and I didn't go back and try to find it again, as I recall it wasn't published in a scientific journal where it would have been peer reviewed prior to publication. If it failed an initial peer review and was subsequently published in some marginally related periodical, it's value might be questionable.

                            Comment


                              #15
                              another article on age and DMT

                              Here is another article about age and stopping DMT:

                              "Stopping disease-modifying therapy (DMT) in patients with multiple sclerosis (MS) after age 60 may be a good strategy, suggests an observational study out of Cleveland Clinic.

                              Our research indicates that being 60 or older is an important predictor of success for discontinuing DMT,” says Cleveland Clinic neurologist Le Hua, MD, who presented findings from the study at the 2018 ECTRIMS (European Committee for Treatment and Research in Multiple Sclerosis) Congress in October."

                              https://consultqd.clevelandclinic.or...-appears-safe/

                              Take Care
                              PPMS for 26 years (dx 1998)
                              ~ Worrying will not take away tomorrow's troubles ~ But it will take away today's peace. ~

                              Comment

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