{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T11:50:22Z","timestamp":1783770622008,"version":"3.55.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT-156363 , FDN-159934"],"award-info":[{"award-number":["PJT-156363 , FDN-159934"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Evidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (&amp;lt;55 and \u226555 years), DMD exposure and health service use in the MS population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18<jats:sup>th<\/jats:sup> birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 19,360 persons with MS (72% were women); 10,741\/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged &amp;lt;55 was 132,283, and 93,594 whilst aged \u226555. Any DMD, versus no DMD in the &amp;lt;55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the \u226555-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (&amp;lt;55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and \u226555 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged &amp;lt;55 at the time of exposure. In contrast, for individuals \u226555 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2021.794075","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T05:21:00Z","timestamp":1642051260000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population"],"prefix":"10.3389","volume":"12","author":[{"given":"Huah Shin","family":"Ng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Graf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Kingwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orhan","family":"Aktas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Albrecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Peter","family":"Hartung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven G.","family":"Meuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charity","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Fisk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinshan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Tremlett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2165\/11532120-000000000-00000","article-title":"Multiple Sclerosis in the Elderly Patient","volume":"27","author":"Awad","year":"2010","journal-title":"Drugs Aging"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-019-0183-3","article-title":"Epidemiology and Treatment of Multiple Sclerosis in Elderly Populations","volume":"15","author":"Vaughn","year":"2019","journal-title":"Nat Rev Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1212\/WNL.0000000000005345","article-title":"Comprehensive Systematic Review Summary: Disease-Modifying Therapies for Adults With Multiple Sclerosis","volume":"90","author":"Rae-Grant","year":"2018","journal-title":"Neurology"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005347","article-title":"Practice Guideline Recommendations Summary: Disease-Modifying Therapies for Adults With Multiple Sclerosis. 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