Disease-modifying therapies (DMTs) are primarily effective through immunomodulation, in that they target relapse prevention, said Burcu Zeydan, MD, assistant professor of neurology, assistant professor of radiology, at Mayo Clinic.
Aging has a noticeable effect on why disease-modifying therapies become less effective as patients get older, especially when you account for the decreases in both CNS reserve and postrelapse recovery potential, explained Burcu Zeydan, MD,assistant professor of neurology, assistant professor of radiology, at Mayo Clinic.
Transcript
Why do disease-modifying therapies (DMTs) lose efficacy as patients with MS age?
Well, when we consider aging-related observations about relapse recovery progression and CNS reserve in multiple sclerosis, it is not surprising that the disease-modifying therapies lose efficacy as patients with MS age. As the CNS reserve decreases with age, the postrelapse recovery potential decreases with age as well. Most importantly, the clinical and subclinical relapses become less frequent with age, while evolution to progressive illness increases with age. So, the existing DMTs are primarily effective through immunomodulation. They target relapse prevention, and they are not specifically meant to prevent progression.
It seems like the optimal window for existing numbered literary DMTs is earlier in life, when the disease is more likely to be active, by preventing some symptomatic relapses and asymptomatic subclinical activity. On the other hand, the currently available DMTs seem to lose efficacy with aging. We know that aging plays a major role in the development of a progressive disease course, with neurodegeneration becoming more prominent and severe disability being closely related to progressive illness.
In a 2017 meta analysis from the NIH, all randomized and blinded MS clinical trials were evaluated. And the efficacy of the DMTs was clearly found to be lowered in older patients compared to younger patients with MS. Although the authors emphasized that efficacy of immunomodulatory DMTs is on disability worsening, strongly decreased with advancing age, they also emphasize that the patient's specific genetic and environmental factors are still important in making treatment decisions.
Overall, the decline in the efficacy of DMTs with older age in MS seems to reflect the impact of aging on the relationship between reserves, relapses, recovery, and progressive MS z-scores mechanisms.
Specialty Pharmacists at the Forefront: Elevating Care for Rare Diseases
May 1st 2024In the US, a disease is considered rare when it affects fewer than 200,000 persons, or 1 in every 1500 individuals, with an estimated total of 25 to 30 million Americans overall living with a rare disease at any given time.
Read More
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Latest Advances and Updates of Treatment in the Real World at AUA
May 1st 2024The annual meeting of the American Urological Association (AUA) not only presents the newest therapies coming out but showcases the latest in how treatments are being used in the real world, said Stephen Freedland, MD, of Cedars Sinai.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
AUA to Focus on Inclusive Care, Robotic Surgeries, and Future of Urology at 2024 Annual Meeting
May 1st 2024The American Urological Association (AUA) 2024 Annual Meeting will highlight the latest innovations and future trends in urology, featuring dynamic plenary sessions, educational opportunities for providers, and discussions on cutting-edge treatments and global health initiatives.
Read More
OptumRx’s Jon Mahrt Discusses “Irresponsible” Drug Pricing for Products With Multiple Indications
April 30th 2024When the same product comes to market with additional indications, irrational pricing decisions result in ever increasing prices instead of volume translating to lower costs, said Jon Mahrt, MBA, of OptumRX.
Read More