IMMUNOSENESCENCE IN MULTIPLE SCLEROSIS: AN INTEGRATIVE REVIEW

Introduction: Immunosenescence is defined as age-related changes in the immune system, leading to an increase in morbidity and mortality in older adults. The most important process of immunosenescence is associated with a decrease in the number of naive T and B cells, NK cells, and disruption of the pro- and anti-inflammatory balance by changes in the production of T cytokines. This decline in the immune system includes not only the natural mechanisms of senility, but also infections, environmental and epigenetic factors, and chronic diseases. Objectives: Review the literature to identify factors of relationship between MS and immunosenescence and how this condition impacts on the prognosis and treatment of the disease. Methods: This is an integrative literature review, of a qualitative nature, based on scientific publications in English, Portuguese and Spanish, from 2018 to 2023. The descriptors “Multiple Sclerosis” and “Immunosenescence” were used in the search in the PubMed and LILACS databases. A total of 15 articles were selected. Results: The studies analyzed confirm that there is a relationship between MS and immunosenescence, as a worse prognosis for older people and lower response to treatment with disease-modifying medications. Authors have proposed a Disease Modifying Therapies (DMTs) de-escalation approach for aging MS patients. High efficacy DMTs are disproportionately more effective early in the disease course, upholding early use. Furthermore, the risk of infections and, to a lesser extent, other adverse events, frequently increase with age. Conclusion: Immunosenescence is associated with a worse prognosis regarding disease progression in older people, as well as a lower response to DMTs. The de-escalation strategies appear to best match disease activity and deserve to be studied in better detail, using randomized controlled trials optimized by use of personalized biomarkers for disease activity, as well as clinical and radiographic monitoring for relapse and disability.