Evidence map›Paper›PMID 40773722›Full record

ArticleNeurology2025

Effectiveness of Disease-Modifying Therapies in Patients With Late-Onset Relapsing-Remitting Multiple Sclerosis.

Sarmad Al-Araji, Marcello Moccia, Ashwani Jha, Le Zhang, Arman Eshaghi, Baris Kanber, Alessia Bianchi, Charmaine Yam, Omar Abdel-Mannan, Olivia Goodkin and 22 more

Abstract read
In one paragraph

Article in Neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
  4. Adult-onset and late-onset multiple sclerosis in older adults in a Finnish university hospital.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
    Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Sarmad Al-ArajiQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0009-0007-0703-6849
Marcello MocciaQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0003-2613-3090
Ashwani JhaNational Institute for Health and Care Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, United Kingdom.ORCID 0000-0003-2835-6837
Le ZhangQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.
Arman EshaghiQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0002-6652-3512
Baris KanberNational Institute for Health and Care Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, United Kingdom.ORCID 0000-0003-2443-8800
Alessia BianchiQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0001-5541-5818
Charmaine YamQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0002-4146-2047
Omar Abdel-MannanQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0002-0796-9645
Olivia GoodkinQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0001-9283-9716
Giuseppe PontilloQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0001-5425-1890
Weaam HamedQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.
Suraya MohamudQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0009-0003-9850-1785
Wallace J BrownleeQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0003-0481-8902
Declan T ChardQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0003-3076-2682
Jeremy ChatawayQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0001-7286-6901
Karen ChungQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.
Floriana De AngelisQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0002-9833-1435
Ahmed HammamNational Hospital for Neurology and Neurosurgery, London, United Kingdom.
Yael HacohenQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0001-8490-9657
Zhaleh KhaleeliQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0009-0006-1820-0344
Siobhan M LearyQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.
Ferran PradosCentre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom.ORCID 0000-0002-7872-0142
Josephine SwantonQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.
Alan J ThompsonQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0002-4333-8496
Sachid Anand TripQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0009-0009-6269-9391
Heather WilsonQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0009-0001-8407-0158
Sarah WrightQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0002-1146-1801
Parashkev NachevNational Institute for Health and Care Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, United Kingdom.ORCID 0000-0002-2718-4423
Frederik BarkhofQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0003-3543-3706
Ahmed T ToosyQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0002-4441-3750
Olga CiccarelliQueen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID 0000-0001-7485-1367

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesThe benefit of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) is believed to decrease with age. We aimed to compare disease outcomes with DMTs between patients with late-onset RRMS (LO-RRMS) and adult-onset RRMS (AO-RRMS).

methodsThis was a single-center, longitudinal, prospective analysis of patients who fulfilled the following criteria: (1) a diagnosis of RRMS and (2) initiation of a new DMT (dimethyl fumarate, fingolimod, glatiramer acetate, natalizumab, and ocrelizumab) within 3 months. Patients were followed up at years 1 and 2. We compared treatment outcomes (relapses, radiologic activity, disability progression, and no evidence of disease activity [NEDA]) between LO-RRMS (defined as age at onset of first symptom >45 years) and AO-RRMS (≥18 years and 45 years) using Poisson, logistic, and Cox regression models while adjusting for baseline variables. The analyses were repeated with an age cutoff of 50 years.

resultsWe studied 1,494 patients with AO-RRMS (mean age at onset: 29.6 years, 71% female) and 150 patients with LO-RRMS (50.2 years, 73% female) at treatment initiation. At DMT commencement, patients with LO-RRMS had shorter disease duration, higher Expanded Disability Status Scale (EDSS), more comorbidities, and were more likely to be treatment naive than patients with AO-RRMS. However, when adjusted, there were no differences in the probability of relapses (Coeff = -0.07; 95% CI -0.19 to 0.04, DISCUSSION: Treatment outcomes over 2 years were similar between LO-RRMS and AO-RRMS. This indicates that care should be taken not to bias treatment decisions due to older age at onset of MS when patients demonstrate evidence of inflammatory activity. Limitations are the observational design, the single-center setting, and a relatively small LO-RRMS group. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that patients with LO-RRMS have comparable outcomes with DMTs as patients with AO-RRMS over a 2-year period; this rating is because of baseline imbalances between treatment groups and a nonmasked outcome assessment.

Indexed as

Immunologic FactorsImmunosuppressive AgentsMultiple Sclerosis, Relapsing-RemittingAdultAge of OnsetDisease ProgressionFemaleFingolimod HydrochlorideGlatiramer AcetateHumansLongitudinal StudiesMaleMiddle AgedNatalizumabProspective StudiesTreatment OutcomeFingolimod HydrochlorideGlatiramer AcetateImmunologic FactorsImmunosuppressive AgentsNatalizumab

Identifiers

PMID40773722
PMCPMC12334343

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.