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However, differences in DMT efficacy appear to decline with increasing age, and the benefit of first-line H-DMT at higher age currently remains unclear. The aim of this study was to investigate whether the superiority of H-DMT over moderate-efficacy DMT (M-DMT) decreases with age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the Austrian MS database, we included previously DMT-na\u00efve RMS patients aged\u2009\u2265\u200918\u00a0years, who (i) initiated a DMT continuing it for\u2009\u2265\u200912\u00a0months, (ii) had MRI at baseline, and (iii) had clinical follow-up for\u2009\u2265\u200924\u00a0months. Cox regression analyses including age and DMT strategy (H-DMT vs. M-DMT) plus an interaction effect were employed to predict time to relapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 215 RMS patients (median age of 41\u00a0years [25\n                      <jats:sup>th<\/jats:sup>\n                      \u201375\n                      <jats:sup>th<\/jats:sup>\n                      percentiles: 32\u201353], 66% females) were observed over a median of 42 (28\u201358) months. During this period, eighty-one (38%) patients had a relapse. While higher age was associated with decreased risk of relapse (hazard ratio (HR) 0.95 per year, 95% confidence interval [CI] 0.93\u20130.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), the use of H-DMT lowered the risk of relapse compared to M-DMT (HR 0.06, 95%-CI 0.01\u20130.45,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007). In patients with H-DMT, the benefit of treatment was reduced by increasing age (HR 1.06 per year, 95%-CI 1.01\u20131.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031). Superiority of H-DMT over M-DMT was not detectable above the age of 52\u00a0years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Efficacy of H-DMT as first-line treatment decreases with increasing age and approximates efficacy of M-DMT above 50\u00a0years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13787-0","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T17:30:34Z","timestamp":1775755834000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of age in choosing high-efficacy treatment for multiple sclerosis: an Austrian MS Database 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Brain 148:626\u2013634. https:\/\/doi.org\/10.1093\/brain\/awae245","journal-title":"Brain"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13787-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-13787-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13787-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:44:22Z","timestamp":1779446662000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-13787-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["13787"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-13787-0","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]},"assertion":[{"value":"15 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Harald Hegen: has participated in meetings sponsored by, received speaker honoraria or travel funding from Bayer, Biogen, Celgene, Janssen, Merck, Novartis, Sanofi-Genzyme, Siemens and Teva, and received honoraria for consulting Biogen, Celgene, Novartis, Roche, and Teva. Fabian F\u00f6ttinger: Has received speaker honoraria and travel funding from Novartis. Janette Walde: nothing to disclose. Klaus Berek: has participated in meetings sponsored by and received travel funding or speaker honoraria from Biogen, Merck, Novartis, Roche, Sanofi, and Teva. He is associate editor of Frontiers in Immunology\/Neurology, Section Multiple Sclerosis and Neuroimmunology. Maria Martinez-Serrat: nothing to disclose. Anna Damulina: has participated in meetings sponsored by, received speaker honoraria or travel funding from Sanofi-Aventis, Novartis and Janssen. Nik Krajnc: has participated in meetings sponsored by, received speaker honoraria or travel funding from Alexion, BMS\/Celgene, Janssen-Cilag, Merck, Novartis, Roche and Sanofi-Genzyme and held a grant for a Multiple Sclerosis Clinical Training Fellowship Programme from the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). Markus Ponleitner: has participated in meetings sponsored by, received speaker or consulting honoraria from Amicus and travel funding from Amicus, Merck, Novartis and Sanofi-Genzyme. Franziska Di Pauli: has participated in meetings sponsored by, received honoraria (lectures, advisory boards, consultations) or travel funding from Bayer, Biogen, BMS\/Celgene, Merck, Novartis, Sanofi, Roche, and Teva. Her institution has received research grants from Roche. Christian Enzinger: has received funding for travel and speaker honoraria from Bayer, Biogen, Merck, Novartis, Roche, Sanofi-Genzyme, Shire and Teva; has received research support from Biogen, Celgene, Merck, and Teva; is serving on scientific advisory boards for Bayer, Biogen, Celgene, Merck, Novartis, Roche and Teva. Florian Deisenhammer: has participated in meetings sponsored by\/received honoraria for acting as an advisor\/speaker for Alexion, Almirall, Biogen, Celgene, Merck, Novartis, Roche, and Sanofi-Genzyme, and his institution received scientific grants from Biogen and Sanofi-Genzyme. Thomas Berger: has participated in meetings sponsored by and received honoraria (lectures, advisory boards, consultations) from pharmaceutical companies marketing treatments for MS: Allergan, Bayer, Biogen, Bionorica, BMS, Eisai, Genesis, GSK, GW\/Jazz Pharma, Horizon, Janssen, MedDay, Merck, Neuraxpharm, Newbridge, Novartis, Octapharma, Roche, Sandoz, Sanofi, Teva, TG Therapeutics and UCB. His institution has received financial support in the past 12\u00a0months by unrestricted research grants (Biogen, Bayer, BMS, Merck, Novartis, Roche, Sanofi, Teva) and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Bayer, Biogen, Merck, Novartis, Octapharma, Roche, Sanofi, Teva. Michael Khalil: has received travel funding and speaker honoraria from Bayer, Biogen, Novartis, Merck, Sanofi and Teva and serves on scientific advisory boards for Biogen, BMS\/Celgene, Gilead, Merck, Novartis, and Roche. He received research grants from Biogen, Novartis and Teva. Gabriel Bsteh: has participated in meetings sponsored by, received speaker honoraria or travel funding from Biogen, Celgene\/BMS, Janssen, Lilly, Merck, Novartis, Roche, Sanofi-Genzyme and Teva, and received honoraria for consulting Biogen, Celgene\/BMS, Janssen, Merck, Novartis, Roche, Sanofi-Genzyme and Teva. He has received unrestricted research grants from Celgene\/BMS and Novartis. He serves as an Executive Committee of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the Board of Directors of the International Multiple Sclerosis VisualSystem Consortium (IMSVISUAL).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}],"article-number":"262"}}