- There has been controversy over the relative benefits of disease-modifying therapies for older people with MS.
- A new Australian study examined real-world evidence for the effectiveness of MS therapies started over the age of 60.
- Ocrelizumab effectively reduced relapses compared with interferon beta or glatiramer acetate, confirming a clear treatment benefit in this age group.
Choosing the best treatment for multiple sclerosis (MS) in older people is complex, given their lower rates of MS relapse, but higher risk of therapy-related infections and side effects.
The effectiveness versus risk of disease-modifying therapies (DMTs) in this group has been unclear, partly because individuals over 60 have historically been excluded from major clinical trials. This lack of evidence complicates therapy decisions for older MS people with MS.
Real-world evidence from MSBase
Professor Helmut Butzkueven, Monash University, Managing Director of MSBase
To help address this question, researchers from Monash University turned to real-world data in the MSBase registry.
Rather than being a clinical trial (where a therapeutic intervention is formally tested head-to-head against other therapies or placebo), MSBase is an ongoing observational study where clinical information is collected from people during the course of their standard MS care.
From its inception in 2004, the Australian-based MSBase registry has been an incredibly powerful resource for answering questions about MS, now including over 90,000 patient records from people with MS in 45 countries.
What was the aim of the study?
Associate Professor Anneke van der Walt, Monash University
In younger people with MS, ocrelizumab is a highly effective therapy, while interferon beta and glatiramer acetate have lower efficacy.
The aim of this study was to determine whether ocrelizumab (Ocrevus®) is more effective than interferon beta (e.g. Rebif®, Betaferon®) or glatiramer acetate (Copaxone®) in people with MS starting these therapies over the age of 60.
 The study was led by Dr Yi Chao Foong and Associate Professor Anneke van der Walt, both recipients of research funding from MS Australia, as well as Professor Butzkueven and Dr Chao Zhu.
What did the researchers do?
Researchers compared outcomes of people with MS who had switched to or started on ocrelizumab, to those starting interferon beta/glatiramer acetate (IFN/GA) over the age of 60.
For each group, they determined the time to the first MS relapse, the average number of relapses per year, and the progression or improvement of disability.
Dr Yi Chao Foong, Monash University
What did the researchers find?
The researchers identified 248 participants commencing ocrelizumab and 427 receiving interferon beta or glatiramer acetate over the age of 60.
The rate of MS relapses and the time to first relapse were lower in those treated with ocrelizumab than with interferon beta or glatiramer acetate.
Overall, there was a low relapse rate in this age group.
However, there was no difference between the therapies in disability progression or disability improvement over 3.57 years.
What does this mean for people with MS?
This study highlights that ocrelizumab is effective in those over 60 with MS. Importantly, it also confirms the benefit of treatment in older people with MS and provides real-world data to guide treatment decisions in older people with MS.
For personalised MS treatment advice, please consult your neurologist and health care team.
