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I'm 70 and my doctor says I am too old for MS treatment. Is that true?

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Updated July 23, 2007

Question: I'm 70 and my doctor says I am too old for MS treatment. Is that true?
The simple answer is no. I spoke to nurses at two of the companies which manufacture the disease-modifying therapies about this issue and they assured me that age alone was not a factor in prescribing any of the current multiple sclerosis (MS) therapies. However, it is possible that you have a type of MS for which treatments are limited or not available.
Answer: Older people are much more likely to have a progressive form of MS, such as secondary-progressive MS (SPMS), primary-progressive MS (PPMS) or progressive-relapsing (PRMS). A large study of 2,156 people with MS found in people with MS over 65, two-thirds were likely to have a progressive form of MS, with only a third having relapsing-remitting MS (RRMS). In people under 65, the proportions were reversed, with the majority having RRMS.

The older injectible therapies (Copaxone, Rebif, Avonex and Betaseron), also known as the CRAB drugs, are all for RRMS. The exception is Betaseron, which is also used for PRMS, a relatively rare form of MS. Tysabri is also for RRMS, and is used in cases where people cannot tolerate or have not responded well to the CRAB drugs.

Novantrone is a drug that is used for some of the progressive forms of MS (SPMS and PRMS). It is given by infusion in the doctor’s office once every three months. However, even if you have one of the forms of MS that Novantrone is approved for, Novantrone might not be for you, as it has serious side effects and, in most cases, cannot be used by anyone who has cardiac problems or who has had chemotherapy.

Unfortunately, if you have PPMS, none of the current disease-modifying therapies is appropriate.

It is also important to note that most MS medications have been tested only in people under the age of 65, as this is often one of the inclusion criteria in clinical trials. While it is not expected that simply being older would be a factor that would make any of the approved drugs dangerous or less effective, it is possible that side effects may be worse.

Having stated some of the reasons why your neurologist might not prescribe one of the disease-modifying treatments, that does not mean that there is nothing that can be done to help your MS. Many treatments are available to help with the MS symptoms that you might be experiencing. In addition, your doctor can prescribe physical therapy, which can help build your muscles and help you learn techniques to compensate for loss of function in certain areas. Occupational therapists can help you to modify your home and your actions to make it easier to do daily activities and self-care. This could include things like adding a bath transfer bench to make it easy to get in and out of the bathtub or rearranging kitchen cabinets to reduce the need to bend down to get items.

If you feel like your doctor is doing all that she can for you, or is not treating your MS as aggressively as she could because of your age, do not hesitate to find a neurologist (preferably one with a larger geriatric patient population) and get a second opinion.

Sources:

Minden SL, Frankel D, Hadden LS, Srinath KP, Perloff JN. Disability in elderly people with multiple sclerosis: An analysis of baseline data from the Sonya Slifka Longitudinal Multiple Sclerosis Study. NeuroRehabilitation. 2004;19(1):55-67.

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