{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T14:15:47Z","timestamp":1778249747934,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis Journal \u2013 Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Relapse prevention in multiple sclerosis (MS) is accomplished with disease-modifying therapy (DMT). Relapse rates typically decrease with age while DMT-associated risks increase, complicating treatment of older persons with MS (PwMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This follow-up study aims to guide treatment decisions by evaluating clinical and patient-reported outcomes among older PwMS who discontinue DMT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included PwMS aged \u226560 evaluated at the Cleveland Clinic from 2010 to 2016, categorized as DMT continuers or discontinuers. Follow-up timeframe was February 2018\u2013April 2024. Outcomes included relapses, magnetic resonance imaging (MRI) activity, and Neuro-QoL and MS Performance Test scores. Mixed-effects regression and survival models were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 600 PwMS were included. Median follow-up time was 10.5 years (interquartile range 7.7\u201313.4), 66.0% discontinued DMT, and 3.3% had \u22651 relapse. Relapse risk did not differ significantly between groups (hazard ratio for discontinuers vs. continuers, 1.80, 95% confidence interval 0.51\u20136.39,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.365). T2 lesions developed in 37.5% of continuers and 36.6% of discontinuers. Gadolinium-enhancing lesions developed in 10.1% and 7.9%, respectively. Neuro-QoL Fatigue T-scores slightly worsened for discontinuers over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Findings demonstrate low relapse risk among PwMS over age 60, however, MRI changes were common. DMT discontinuation may be considered in this population, though further studies are needed to better understand radiological disease activity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552173261448005","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T13:08:26Z","timestamp":1778072906000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term follow-up of patients with multiple sclerosis over age 60: Comparing clinical and radiological outcomes in disease-modifying therapy continuers and discontinuers"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7716-8465","authenticated-orcid":false,"given":"Daniel R","family":"Orme","sequence":"first","affiliation":[{"name":"Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Matesen","sequence":"additional","affiliation":[{"name":"University of Nevada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5359-6686","authenticated-orcid":false,"given":"Devon","family":"Conway","sequence":"additional","affiliation":[{"name":"Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8973-5219","authenticated-orcid":false,"given":"Nicolas","family":"Thompson","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"},{"name":"Center for Outcomes Research &amp; Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0535-3978","authenticated-orcid":false,"given":"Le H","family":"Hua","sequence":"additional","affiliation":[{"name":"Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.4.662"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00184-3"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2008.145805"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.smim.2012.04.008"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585241266180"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-017-0771-9"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-12047-9"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2022-329049"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-019-0183-3"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-021-00556-y"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-023-01038-z"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458518765656"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.104706"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458516675751"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2023.107612"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.07.021"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2015-032"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000960"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-10074-4"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2024.105503"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00154-0"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.4164"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14162"},{"key":"e_1_3_2_25_2","article-title":"The multiple sclerosis performance test (MSPT): an iPad-based disability assessment tool","volume":"88","author":"Rudick RA","year":"2014","unstructured":"Rudick RA, Miller D, Bethoux F, et al. 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