{
  "abstract": "Background As the average age of multiple sclerosis (MS) population rises globally, unclear guidelines on disease-modifying therapy (DMT) use in older persons with MS (pwMS) contribute to increased variability in clinical practice. The factors driving DMT utilisation in this population are not well understood. We explored DMT utilisation patterns in pwMS aged 55 and older enrolled in the Swiss MS Registry (SMSR), a nationwide observational study with voluntary participation.Methods We conducted an exploratory analysis using data from SMSR participants who had reported DMT status in the most recent follow-up survey and at least once within the previous 3 years. Participants were categorised and compared by current and past DMT use: No DMT (no use), Stopped (prior use), Continued (same DMT), Switcher (changed DMT) and New (initiated DMT). Log-binomial regression identified factors associated with non-use, grouping participants as No DMT (No DMT, Stopped) and DMT (Continued, Switcher, New).Results Among 378 participants (mean age 63.2±6.7 years), 206 (54.5%) reported DMT use: 176 (46.6%) continued the same DMT, 20 (5.3%) switched and 10 (2.6%) newly initiated DMT. Among non-users, 54 (14.3%) had stopped treatment, while the rest did not use DMT during the study period. In participants with regular neurological care, longer MS duration (relative risk (RR)=1.018, 95% CI 1.008 to 1.028) and older age (RR=1.016, 95% CI: 1.001 to 1.032) were associated with higher likelihood of DMT non-use, and participants with primary (RR=1.736, 95% CI: 1.175 to 2.565) and secondary progressive MS (RR=1.423, 95% CI: 1.023 to 1.981) were more likely not to use DMTs compared with relapsing-remitting MS. No significant associations were observed in participants without regular neurological follow-up.Conclusions Despite unclear efficacy and safety, many older pwMS continue DMT use. Use is primarily associated with relapsing-remitting MS, while age and disease duration show only modest or no association.",
  "authors": [
    {
      "affiliations": [
        "Department of Epidemiology, University of Zurich Institute of Epidemiology Biostatistics and Prevention, Zürich, Switzerland",
        "University of Zurich Institute for Implementation Science in Health Care, Zürich, Switzerland"
      ],
      "name": "Mina Stanikić"
    },
    {
      "affiliations": [
        "Department of Neurology, Ruhr University Bochum, Bochum, NRW, Germany"
      ],
      "name": "Anke Salmen"
    },
    {
      "affiliations": [
        "Department of Neurology, Inselspital Universitatsspital Bern, Bern, BE, Switzerland",
        "Neurocentre, Luzerner Kantonsspital, Lucerne, LU, Switzerland"
      ],
      "name": "Christian P Kamm"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Zurich, Zürich, ZH, Switzerland"
      ],
      "name": "Patrick Roth"
    },
    {
      "affiliations": [
        "Deptartment of Neurology, University Hospital Basel, Basel, BS, Switzerland",
        "Neuropsychology and Behavioral Neurology Unit, University of Basel, Basel, BS, Switzerland"
      ],
      "name": "Pasquale Calabrese"
    },
    {
      "affiliations": [
        "Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland",
        "Universita della Svizzera italiana Facolta di scienze biomediche, Lugano, TI, Switzerland"
      ],
      "name": "Chiara Zecca"
    },
    {
      "affiliations": [
        "Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland",
        "Universita della Svizzera italiana Facolta di scienze biomediche, Lugano, TI, Switzerland"
      ],
      "name": "Claudio Gobbi"
    },
    {
      "affiliations": [
        "Rehabilitation Clinic Zihlschlacht, Zihlschlacht-Sitterdorf, Switzerland"
      ],
      "name": "Claudia Baum"
    },
    {
      "affiliations": [
        "Department of Clinical Research, University of Bern, Bern, Switzerland"
      ],
      "name": "Benjamin Victor Ineichen"
    },
    {
      "affiliations": [
        "Department of Epidemiology, University of Zurich Institute of Epidemiology Biostatistics and Prevention, Zürich, Switzerland",
        "University of Zurich Institute for Implementation Science in Health Care, Zürich, Switzerland"
      ],
      "name": "Viktor von Wyl"
    },
    {
      "affiliations": [],
      "name": "on behalf of Swiss Multiple Sclerosis Registry"
    }
  ],
  "title": "Real-world use of disease-modifying therapy in persons with multiple sclerosis aged 55 and over",
  "uid": "859d0189-1d84-508a-b1c8-127d963ff9bf"
}