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Evaluate the efficacy and safety of disease-modifying therapies in multiple sclerosis patients across different age groups.

June 14, 2026Open Access

The impact of age on efficacy and safety of disease modifying treatment—insights from the Austrian Multiple Sclerosis Treatment Registry

MGMichael GugerJohannes Kepler University of Linz CEChristian EnzingerMedical University of Graz BHBettina HeschlMedical University of Graz

Key Points

Evaluate the efficacy and safety of disease-modifying therapies in multiple sclerosis patients across different age groups.
Included patients from the Austrian MS Treatment Registry receiving treatment for at least 12 months.
Patients categorized into two age groups: < 50 years (n = 1,459) and ≥ 50 years (n = 658).
Applied generalized linear model and Cox proportional hazards models to assess treatment effects.
Mean annualized relapse rates were 0.12 (younger cohort) and 0.09 (older cohort), p < 0.001.
Cox regression showed a hazard ratio of 1.34 (95% CI 1.12-1.60, p = 0.001) for relapse risk in younger patients.
EDSS progression hazard ratios were 0.76 (p = 0.003) and 0.70 (p < 0.001) for the older cohort at 12 and 24 weeks.

Abstract

INTRODUCTION: Efficacy and safety considerations in the treatment of multiple sclerosis (MS) change over a person's lifetime due to immunosenescence and the increasing prevalence of comorbidities with advancing age. OBJECTIVES/AIMS: To evaluate the overall efficacy and safety of disease-modifying therapies in MS patients across different age groups using prospectively collected real-world data from a nationwide observational cohort. METHODS: We included patients from the Austrian MS Treatment Registry (AMSTR) who were receiving treatment with Alemtuzumab, Cladribine, Dimethyl fumarate, Fingolimod, Natalizumab, Ocrelizumab, Ofatumumab, Ozanimod, Ponesimod, Siponimod, and Teriflunomide for at least 12 months as of March 2025. Patients were categorized into two age groups: < 50 years (n = 1,459) and ≥ 50 years (n = 658). A generalized linear model (GLM) and Cox proportional hazards models were applied to assess treatment effects on annualized relapse rates (ARR) and changes in the Expanded Disability Status Scale (EDSS), including both progression and improvement. RESULTS: Over a mean treatment duration of 6.0 years (younger cohort) and 7.8 years (older cohort), the estimated mean ARR was 0.12 and 0.09, respectively (p < 0.001). Cox regression analysis of time to first relapse yielded a hazard ratio (HR) of 1.34 (95% CI 1.12-1.60, p = 0.001), indicating a significantly higher relapse risk for the younger cohort. For sustained EDSS progression at 12 and 24 weeks, the corresponding HRs were 0.76 (95% CI 0.64-0.912, p = 0.003) and 0.70 (95% CI 0.58-0.85, p < 0.001), respectively, demonstrating a higher risk of disability progression in the older cohort. CONCLUSION: Our findings indicate that approximately one-third of treated MS patients in our registry are aged 50 years or older, underscoring the substantial presence of older patients in contemporary MS treatment cohorts. Furthermore, efficacy outcomes, including ARR and EDSS progression, differed significantly between younger and older age groups. These results suggest that both disease activity and chronological age are primary determinants of treatment outcomes.

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