Clinical characteristics, disability outcomes, and disease-modifying therapy patterns in late-onset multiple sclerosis: a single-center retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Late-onset multiple sclerosis (LOMS), defined here as symptom onset at age 50 years or later, is associated with diagnostic complexity, a higher prevalence of progressive phenotypes, greater disability, and challenging disease-modifying therapy (DMT) decisions. We characterized clinical manifestations, magnetic resonance imaging (MRI) lesion distribution, disability outcomes, and DMT patterns in a Latvian tertiary-care cohort. Methods We retrospectively reviewed medical records from Riga East University Hospital. Of 518 patients in the source multiple sclerosis dataset, 59 met the LOMS definition; after exclusion of two patients with clinically isolated syndrome and one with an unspecified phenotype, 56 patients with relapsing-remitting, primary progressive, or secondary progressive multiple sclerosis were analyzed. Clinical symptoms, MRI lesion localization, baseline and five-year Expanded Disability Status Scale (EDSS) scores, EDSS change, and initial and current DMT patterns were assessed using nonparametric and exact tests. Results The cohort included 38 women and 18 men; 38 patients had relapsing-remitting multiple sclerosis and 18 had progressive multiple sclerosis. Progressive phenotypes were associated with more frequent pyramidal/motor symptoms (100.0% vs. 76.3%; p = 0.045) and bowel/bladder dysfunction (72.2% vs. 42.1%; p = 0.035). Baseline EDSS was higher in progressive disease (median 3.75 vs. 2.00; p < 0.001), as was five-year EDSS among the 39 patients with available follow-up (median 6.00 vs. 3.00; p < 0.001), whereas EDSS change did not differ significantly ( p = 0.377). Anti-CD20 and other high-efficacy DMTs were used more frequently in progressive phenotypes and in patients with greater observed disability. Conclusion Progressive LOMS phenotypes were associated with greater motor and sphincter symptom burden and higher disability, but the absence of a difference in unadjusted EDSS change should not be interpreted as equivalent disability progression. Treatment associations primarily describe real-world selection and are subject to confounding by indication.
Source: Frontiers in Neurology
Institutions: Riga Stradiņš University, Riga East University Hospital
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223092988