| Abstract [eng] |
Background. Late-onset multiple sclerosis presents clinical and therapeutic challenges, but real-world data is lacking. Aim. To determine the demographic, clinical, disease course, and treatment characteristics of people with late-onset multiple sclerosis compared with adult-onset multiple sclerosis. Objectives. To compare demographic characteristics and initial presentation. To compare diagnostic delay and the significance of intrathecal immunoglobulin synthesis. To assess disability, relapses, and types of disease course types. To determine the characteristics of disease-modifying therapy. Methods. A retrospective observational study analyzed demographic, clinical, and treatment data of confirmed multiple sclerosis cases at Vilnius University Hospital Santaros Klinikos between 2000 and 2025. Statistical analysis included Fisher's, Fisher-Freeman-Halton’s, McNemar’s exact and Pearson χ², McNemar-Bowker, Mann-Whitney U tests, alongside a sensitivity analysis. Results presented as frequencies and medians (interquartile range (Q1–Q3)). Results. A total of 1345 subjects were included: adult-onset multiple sclerosis (18–50 years, N = 1102) and late-onset multiple sclerosis (> 50 years, N = 243; 18.1 %). The female-to-male ratios did not differ between groups (~1.9:1). Late-onset disease more frequently presented with supratentorial symptoms (59.8 % vs 47.3 %, p < 0.001), and longer time to diagnosis (2.1 (0.4–8.1) vs 0.6 (0.1–3.2) years, p < 0.001). Values of oligoclonal bands (p = 0,234) and the immunoglobulin G index (p = 0,779) did not differ. Late-onset form displayed a higher frequency of primary (20.8% vs 3.0%) and secondary progressive (26.4% vs 6.3%) courses (p < 0.001), a greater initial Expanded Disability Status Scale (4.0 (3.0–5.0) vs 2.5 (2.0–3.5) points, p < 0.001), and faster annualized score (0.23 (0.14–0.38) vs 0.16 (0.09–0.27) points per year, p < 0.001). The annualized relapse rate did not differ, relapses of late-onset disease required glucocorticosteroids more often (72.1 (50.0–100.0) vs 66.6 (0.0–83.3) %, p = 0.039). Disease-modifying theraphy was prescribed less (95.5 vs 98.5 %, p = 0.005) but initiated more with high-efficacy drugs (17.1 % vs 11.3 %, p = 0.023). Treatment escalation rates did not differ between groups (p = 0,215). Conclusions. Late-onset disease accounts for nearly one-fifth of multiple sclerosis cases. Despite similar sex ratios, it presents more supratentorial symptoms and a 1.5-year longer diagnostic delay. Intrathecal immunoglobulin synthesis markers remain equally reliable. Disability accumulates faster, progressive forms dominate alongside more severe relapses in late-onset multiple sclerosis. Disease-modifying therapy is prescribed less often, yet more frequently initiated with high-efficacy medications; age does not limit treatment escalation. |
