MS prognosis closely linked with sex, hormones and age

WEST PALM BEACH, Fla. — A review of studies on MS prognosis revealed that sex differences and hormones are correlated with age, according to a presentation at the ACTRIMS Forum.

“The aim (of research and developing clinical solutions) is to prevent or delay the transition from asymptomatic RIS to symptomatic MS, to also improve recovery and (create) a slower transition to the progressive phase of MS as well as symptom worsening,” Burcu Zeydan, MD, PhD, assistant professor of neurology and radiology at the Mayo Clinic, said during the presentation.

Citing more than two dozen studies, clinical trials and recent scientific updates on aging and sex in MS prognosis, Zeydan said that age is the primary determinant in the transition to the progressive phase in MS for both men and women, and that clinical and subclinical activity decreases with aging, as does the potential for recovery. In addition, the efficacy of disease modifying therapy decreases, and adverse events associated with DMTs increase in MS patients with age.

Zeydan also stated that MS and RIS are more common in women by a 3-to-1 ratio, but men are more likely to rapidly transition from RIS to symptomatic MS or primary progressive MS; MS risk in the pre-adolescent years is equal between sexes.

In addition, women are prone to more inflammatory events and common relapses, but they have better relapse recovery than men, who tend to present with more motor than sensory relapses.

The relapsing-remitting phase of the disease (which presents around age 45, per cited studies) tends to begin at an earlier age in women, while the onset of disability is more rapid for men. In the progressive phase (age 50 and older), onset is earlier for men, but disability is more rapid for women. During the first presentation of symptoms for early-onset MS, the rate of disability is faster in men; for late-onset MS, disability rates are equal for men and women.

Menopause is closely related to aging and neurodegeneration and is likely to be associated with both progressive MS and disability worsening. Older age at menarche may delay severe disability.

Pregnancy appears to decrease overall MS risk (46% lower risk than those who have not borne children), is associated with slowing of disability worsening and has been shown to delay the onset of MS in its progressive phase, per the presentation. Further, pregnancy decreased relapses by 70%, while relapses spiked to 170% postpartum.

The use of estrogen, progesterone and testosterone at age-appropriate intervals suggests a decrease of neurodegeneration during age progression, but the effectiveness of these hormones has yet to be established in larger trials.

“The findings are highly suggestive of long-term beneficial effects of sex hormones in MS prognosis,” said Zeydan. “The main question is the use of adjunct sex hormone therapy in the future in MS management.”