Androgen-modifying treatments extend last disease activity in older men with MS

SAN DIEGO — Older men with MS who used androgen-modifying treatments experienced last disease activity at a later age compared with women and men who refrained from these treatments, according to a poster at ACTRIMS 2023.

“Men, and specifically older men, are underrepresented in the MS research population since [disease] frequency is lower in men,” Nur Neyal, MD, a postdoctoral research fellow in the departments of neurology and radiology at the Mayo Clinic, told Healio in an interview.

Neyal and colleagues examined disease activity in older men with MS who were on androgen-modifying treatments (AMTs) for benign prostate hyperplasia or prostate cancer, as testosterone is known to interfere with neuroinflammatory pathways.

Utilizing Mayo Clinic’s institutional search engine, researchers identified 143 individuals with MS on AMTs and included 41 for analysis, of whom 15 had MS disease activity after AMT initiation (mean age, 67.1 years). They were matched by age at last clinical visit and MS phase to two control groups: 15 men not prescribed AMTs and 15 women.

Neyal and colleagues collected data on disease onset and phase (relapsing or progressive), age at last clinical visit and radiological activity, onset of progressive MS, and initiation and discontinuation of AMTs.

In the AMT group, the age at treatment initiation was 60.2 ± 7.9 years, with an older age at last clinical activity (63.6 ± 6.3 years) compared with other MS patients (men without AMT, 49.4 ± 12.7 years; women, 47.9 ± 10.2 years).

In addition, researchers found that age at last disease activity (radiological and/or clinical) was later for the men on AMTs compared with the control groups.

“Men who used these drugs had inflammatory activity at older ages than the ones who didn’t [use AMTs],” Neyal said. “If men are using, we should follow up more closely.”