Koch MW, Mostert J, Zhang Y, et al. - The findings suggested that the relationship between age and the incidence of the contrast-enhancing lesion (CEL) is a common phenomenon across the spectrum of multiple sclerosis (MS) disease courses. The results should be validated using real-world MS datasets.

• CombiRx involved 1,008, ASCEND [A Clinical Study of the Efficacy of Natalizumab on Reducing Disability Progression in Participants With Secondary Progressive Multiple Sclerosis] 889, PROMISE 943, and INFORMS 970 candidates. CEL frequency varied by disease course at baseline: 39.6% of CombiRx, 23.9% of ASCEND, 14.0% of PROMISE, and 12.3% of INFORMS participants had CELs.

• Within each age group, this distribution by disease course was largely preserved.

• With increasing age, the fraction of people with CELs decreased approximately linearly in all datasets.

• After one year of experimental treatment, CEL occurrence was reduced in all trial datasets and was nearly non-existent in ASCEND.

• After one year of treatment, the decrease of CEL occurrence with increasing age was preserved in CombiRx, PROMISE, and INFORMS.

• Using multivariable binary logistic regression models, the authors evaluated the association of the baseline parameters age, disease duration, gender, and EDSS with having CELs at baseline.

• In all datasets, the only factor linked with the risk of CELs at baseline was age, with older people having a decreased risk of CELs.