From the FDA Drug Label
Fingolimod capsules are indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in patients 10 years of age and older. The answer to whether multiple sclerosis (MS) can occur in older patients is not directly addressed in terms of an upper age limit, but the indication for fingolimod starts at 10 years of age and older.
- Key point: The drug label does not specify an upper age limit for the occurrence of MS, but it does indicate that fingolimod is used in patients 10 years of age and older 1. Since the label does not directly address the question of whether MS can occur in older patients, no conclusion can be drawn about the specific age limit from this information alone.
From the Research
Yes, multiple sclerosis (MS) can occur in older patients, although it is less common than in younger adults. While MS is typically diagnosed between ages 20-40, approximately 5% of cases are diagnosed after age 50, referred to as late-onset MS (LOMS) 2. Older patients with MS may present with different symptoms than younger patients, often showing more progressive disease courses from the beginning and less inflammatory activity. The diagnosis can be challenging in older adults because symptoms may be mistaken for other age-related conditions or comorbidities.
Key Considerations
- MRI findings in older patients may show fewer inflammatory lesions but more degenerative changes.
- Treatment approaches for older MS patients often require careful consideration of age-related factors, including potential drug interactions with medications for other conditions, altered drug metabolism, and increased risk of side effects.
- While the same disease-modifying therapies used for younger patients may be prescribed, physicians typically weigh the benefits against potential risks more cautiously in older populations.
- Regular monitoring is particularly important for older MS patients to manage both the disease and potential treatment complications. Some studies suggest that the proportion of LOMS cases is around 5.01% (95% CI: 3.78% to 6.57%) of total MS cases 2. The clinical features of LOMS can vary, but motor dysfunction is often the most common first presentation, followed by sensory problems, visual symptoms, and brainstem dysfunction 2.
Clinical Features and Diagnosis
- The proportion of positive oligoclonal band (OCB) and positive immunoglobulin G (IgG) index can also vary in LOMS cases 2.
- A family history of MS is present in about 2.2% - 12.5% of LOMS cases 2. Understanding the proportion and clinical features of LOMS is crucial for clinicians to diagnose and manage MS in older adults effectively, and to prevent wrong management plans and complications in these patients 2.