First-line therapies in Late Onset Multiple Sclerosis: an Italian registry study

Background: The diagnosis of late onset (≥50 years) relapsing remitting multiple sclerosis (LORRMS) has been increasingly described in clinical practice, at the same time, data focusing on the specific therapeutic management of LORRMS are scarce. Objective: To compare effectiveness of injectable and oral first line disease modifying therapies (DMTs) in a cohort of LORRMS patients with for time to first relapse, time to confirmed disability progression (CDP), and, additionally, for time to discontinuation. Methods: This is a multicenter, observational, retrospectively acquired cohort study on LORRMS-naïve patients from the Italian MS Register who started either injectable or oral first line DMTs between January 1, 2013 and December 31, 2017. LORRMS were divided into two groups, namely the injectable group (IG) and oral group (OG). Cox models adjusted with inverse probability weighted propensity score were built for the investigated outcomes. Results: Of a cohort of 3,989 patients, 302 were enrolled (203 in the IG and 99 in the OG). The two cohorts did not differ for baseline characteristics. Time to first relapse did not show any difference between the two groups (HR = 1.10; CI 95% 0.50-2.46, p=.797). Furthermore, no differences were found between the two groups with respect to the risk of CDP (HR = 1.04; CI 95% 0.35-3.06, p = .939), nor for the risk of DMT discontinuation (HR = 0.90; CI 95% 0.17-2.08, p =.425). Conclusions: Real-world data from the Italian MS Register suggested that both injectables and oral first line DMTs controlled similarly the investigated outcomes in LORRMS.