Life expectancy in multiple sclerosis: what the studies really say (2026)
MS is not a terminal illness — most patients live only 5–10 years less than the general population, and the newest studies show that early DMT therapy dramatically narrows that gap. A review of large registry studies (Finland, Denmark, New Zealand, US, France), main causes of death, effect of MS phenotype, and concrete steps proven to extend life.
Does MS shorten life?
In conversations with people in the MS community, this is one of the questions that keeps coming back. Multiple sclerosis is not a terminal disease. Most people with MS live for decades after diagnosis, many into their late 70s and 80s. Still, large population studies show a moderate difference in life expectancy compared with the general population — historically about 7 years shorter, while the newest studies (particularly in the era of high-efficacy DMTs) show that gap is closing [1](#ref-1)[2](#ref-2).
MS Trust, one of the most influential UK patient organisations, summarises the data this way: "MS does reduce life expectancy, but the impact is small for most people; many live as long as the general population" [3](#ref-3).
What the largest studies show
Norway (60-year study, JNNP 2017)
A longitudinal study from the Hordaland region followed patients for 60 years. Median survival from symptom onset was 74.7 years in MS patients versus 81.8 years in the general population — a difference of ~7 years. The standardised mortality ratio (SMR) was 2.7 but clearly fell in more recent cohorts [1](#ref-1).
Denmark (registry analysis, Eur J Neurol 2025)
An analysis of the entire Danish MS registry shows relapsing MS (RRMS) had a slightly increased mortality, while primary-progressive MS (PPMS) had a markedly higher death rate. Conclusion: disease phenotype strongly shapes outcome [4](#ref-4).
Finland (national cohort, J Neurol 2025)
The newest Finnish registry study (published 2025) confirms that excess mortality is stable and moderate, with the leading causes of death being cardiovascular disease, infections (pneumonia and urosepsis), cancers and MS itself. Excess mortality attributable to MS itself has fallen in the modern DMT era [5](#ref-5).
New Zealand (national study, JNNP 2023)
A prospective national study showed median survival from diagnosis of ~35 years, with markedly better outcomes in patients who started DMTs early [6](#ref-6).
United States (1999–2020 analysis, MSARD 2024)
A retrospective analysis of every US MS-related death over 22 years found a gradual decline in the annual mortality rate among women, while it stayed roughly stable in men. A narrowing gap between racial groups was also observed [7](#ref-7).
France (WNL 2021)
A French nationwide study showed excess mortality rises with age and disease duration, but that in patients under 45 the difference is minimal — a strong argument for early treatment [8](#ref-8).
Impact of MS type on life expectancy
- Relapsing-remitting MS (RRMS): today, with effective DMT therapy, life expectancy is very close to the general population. The gap is estimated at 2–6 years [4](#ref-4).
- Secondary progressive MS (SPMS): roughly 5–10 years shorter, but shrinking when the transition to SPMS is delayed with modern drugs.
- Primary progressive MS (PPMS): historically the biggest gap (10–15 years), partly due to late diagnosis and fewer approved therapies; improving today with Ocrevus.
- Benign MS (EDSS ≤ 3 after 15 years): life expectancy is essentially the same as the general population.
More on phenotype differences in our [guide to MS progression](/en/blog/znaci-napredovanje-ms-progression).
Main causes of death in MS
Analyses of several national registries agree on this order:
1. Cardiovascular disease — heart attack and stroke; risk is raised by reduced physical activity, obesity and smoking [5](#ref-5).
2. Infections — pneumonia (especially aspiration), urosepsis from chronic bladder dysfunction, pressure ulcers in advanced EDSS [1](#ref-1).
3. Cancers — at rates similar to the general population; slightly increased risk of bladder cancer (chronic UTIs) and lymphoma on long-term immunosuppression [5](#ref-5).
4. Suicide — 1.6–2× more common than in the general population, especially in the first five years after diagnosis; highlights the importance of early psychological support [9](#ref-9).
5. MS itself (direct complications) — respiratory failure or dysphagia in the late phase of PPMS/SPMS; now rare in well-treated patients.
How DMTs prolong life
A Canadian study of 5,989 patients (Palmer et al., Neurol Neuroimmunol Neuroinflamm 2022) was the first to clearly demonstrate that DMTs prolong survival. Patients exposed to any DMT had a hazard ratio for death of 0.68 (a 32% risk reduction) versus unexposed patients. The effect was stronger with longer exposure and with high-efficacy options [10](#ref-10).
Registry data from the New York State MS Consortium and the Danish registry further show that:
- DMTs started early (within 2 years of diagnosis) delay the transition to SPMS by 5–8 years.
- Switching to high-efficacy drugs (Ocrevus, Kesimpta, Tysabri, Mavenclad) further reduces mortality compared with older injectables.
- Patients who never interrupt therapy have the best prognosis.
For details on each drug see our guides: [Ocrevus](/en/blog/ocrevus-okrelizumab-kompletan-vodic-multipla-skleroza-srbija), [Kesimpta](/en/blog/kesimpta-ofatumumab-kompletan-vodic-multipla-skleroza-srbija), [Tysabri](/en/blog/tysabri-natalizumab-kompletan-vodic-multipla-skleroza-srbija), [Mavenclad](/en/blog/mavenclad-kladribin-kompletan-vodic-multipla-skleroza-srbija), [Tecfidera](/en/blog/tecfidera-dimetil-fumarat-kompletan-vodic-multipla-skleroza-srbija) and [Copaxone](/en/blog/copaxone-glatiramer-acetat-kompletan-vodic-multipla-skleroza-srbija).
Factors proven to extend life with MS
Early treatment with an effective DMT
The single largest factor. Delaying therapy by just 2 years measurably shortens expected life [10](#ref-10).
Quitting smoking
Smokers with MS have 50% faster disability progression and significantly shorter life expectancy. Quitting at any stage reduces that risk [11](#ref-11).
Controlling cardiovascular risk factors
Hypertension, diabetes and hyperlipidaemia accelerate brain atrophy and mortality. Regular blood pressure, HbA1c and lipid checks are essential [5](#ref-5).
Adequate vitamin D
Low D correlates with worse prognosis; replacement to 75–125 nmol/L is now routine [12](#ref-12). More in our [vitamin D article](/en/blog/vitamin-d-ms-nauka).
Regular physical activity
Aerobic activity 150 min/week + strength training 2×/week reduces all-cause mortality by ~30% and slows brain atrophy. Adapted exercises for every EDSS level are in our [exercise guide](/en/blog/joga-multipla-skleroza-edss-nivoi).
Infection prevention
Annual influenza vaccine, pneumococcal vaccine, and — on anti-CD20 therapy — timely antibiotic prophylaxis for urinary infections reduce the most common causes of death [5](#ref-5).
Mental-health support
Early identification of depression and suicidal ideation — especially in the first 5 years after diagnosis — saves lives [9](#ref-9). See our [mental-health article](/en/blog/mentalno-zdravlje-ms-smernice).
Healthy weight and Mediterranean diet
Midlife obesity is linked to worse MS outcomes; a Mediterranean pattern is linked to better cognitive scores [13](#ref-13). More in our [diet guide](/en/blog/ms-dijeta-mediteranski-rezim).
What the numbers mean for the individual
Statistics are population-level — they do not predict an individual's fate. A person diagnosed today at 30 with RRMS, who starts a high-efficacy drug early, does not smoke and exercises regularly, will likely live almost as long as their peers. On the other hand, PPMS diagnosed at 55 with cardiovascular comorbidity and smoking has a considerably shorter prognosis — yet even there a lot can be changed.
Bottom line
MS is a chronic disease that can shorten life by a few years, but it does not have to. Early DMT therapy, quitting smoking, controlling cardiovascular risk, regular physical activity and mental-health support — proven to give those years back. For most patients diagnosed today, on modern therapy, MS is a disease you live long with, not one you die early from.
Key studies mapped to claims
Map of which claim relies on which reference.
- Historical ~7-year gap and falling SMR in recent cohorts: Lunde et al., JNNP 2017 [1](#ref-1); Scalfari et al., JNNP 2013 [2](#ref-2); MS Trust — Life expectancy [3](#ref-3).
- Phenotype differences in mortality (RRMS vs PPMS): Magyari et al., Eur J Neurol 2025 [4](#ref-4).
- Main causes of death (CVD, infections, cancers): Finnish registry study, J Neurol 2025 [5](#ref-5).
- Median survival from diagnosis and impact of early DMTs: Leadbetter et al., JNNP 2023 [6](#ref-6).
- US mortality trend 1999–2020: MSARD 2024 [7](#ref-7).
- Excess mortality by age and disease duration: Leray et al., Neurology 2021 [8](#ref-8).
- Increased suicide risk in the first years after diagnosis: Feinstein and Pavisian, Neurology 2017 [9](#ref-9).
- DMTs and prolonged survival (HR 0.68): Palmer et al., NNN 2022 [10](#ref-10).
- Smoking and faster MS progression: Ramanujam et al., JAMA Neurol 2015 [11](#ref-11).
- Vitamin D and MS prognosis: Sintzel et al., Neurol Ther 2018 [12](#ref-12).
- Mediterranean diet and better cognitive outcomes: Katz Sand et al., Neurology 2023 [13](#ref-13).
Sources and references
1. {#ref-1} Lunde HMB, Assmus J, Myhr KM, Bø L, Grytten N. *Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study.* J Neurol Neurosurg Psychiatry. 2017;88(8):621–625. [DOI: 10.1136/jnnp-2016-315238](https://doi.org/10.1136/jnnp-2016-315238).
2. {#ref-2} Scalfari A, Knappertz V, Cutter G, Goodin DS, Ashton R, Ebers GC. *Mortality in patients with multiple sclerosis.* Neurology. 2013;81(2):184–192. [DOI: 10.1212/WNL.0b013e31829a3388](https://doi.org/10.1212/WNL.0b013e31829a3388).
3. {#ref-3} MS Trust. *Life expectancy.* Last updated March 2024. [mstrust.org.uk/a-z/life-expectancy](https://mstrust.org.uk/a-z/life-expectancy).
4. {#ref-4} Elberling F, Koch-Henriksen N, Magyari M. *The Phenotypes of Multiple Sclerosis Differ Significantly in Relative and Excess Mortality.* Eur J Neurol. 2025. [DOI: 10.1111/ene.70122](https://doi.org/10.1111/ene.70122).
5. {#ref-5} Sumelahti ML et al. *Mortality and causes of death for people with multiple sclerosis: a Finnish nationwide register study.* J Neurol. 2025;272:370. [DOI: 10.1007/s00415-025-13112-1](https://doi.org/10.1007/s00415-025-13112-1).
6. {#ref-6} Leadbetter R, MacAskill M, Myall DJ, Taylor BV, Joshi P, Mason DF. *Multiple sclerosis mortality in New Zealand: a nationwide prospective study.* J Neurol Neurosurg Psychiatry. 2023. [DOI: 10.1136/jnnp-2022-330582](https://doi.org/10.1136/jnnp-2022-330582).
7. {#ref-7} *Trends in mortality due to multiple sclerosis in the United States: A retrospective analysis from 1999 to 2020.* Mult Scler Relat Disord. 2024. [DOI: 10.1016/j.msard.2024.105726](https://doi.org/10.1016/j.msard.2024.105726).
8. {#ref-8} Leray E et al. *Effects of Age and Disease Duration on Excess Mortality in Patients With Multiple Sclerosis From a French Nationwide Cohort.* Neurology. 2021. [DOI: 10.1212/WNL.0000000000012224](https://doi.org/10.1212/WNL.0000000000012224).
9. {#ref-9} Feinstein A, Pavisian B. *Multiple sclerosis and suicide.* Mult Scler. 2017;23(7):923–927. [DOI: 10.1177/1352458517702553](https://doi.org/10.1177/1352458517702553).
10. {#ref-10} Palmer AJ, Fisk JD, Marrie RA et al. *Disease-Modifying Drugs for Multiple Sclerosis and Association With Survival.* Neurol Neuroimmunol Neuroinflamm. 2022;9(5):e200005. [DOI: 10.1212/NXI.0000000000200005](https://doi.org/10.1212/NXI.0000000000200005).
11. {#ref-11} Ramanujam R, Hedström AK, Manouchehrinia A et al. *Effect of Smoking Cessation on Multiple Sclerosis Prognosis.* JAMA Neurol. 2015;72(10):1117–1123. [DOI: 10.1001/jamaneurol.2015.1788](https://doi.org/10.1001/jamaneurol.2015.1788).
12. {#ref-12} Sintzel MB, Rametta M, Reder AT. *Vitamin D and Multiple Sclerosis: A Comprehensive Review.* Neurol Ther. 2018;7(1):59–85. [DOI: 10.1007/s40120-017-0086-4](https://doi.org/10.1007/s40120-017-0086-4).
13. {#ref-13} Katz Sand I et al. *Diet quality and cognitive function in multiple sclerosis.* Neurology. 2023. [DOI: 10.1212/WNL.0000000000207214](https://doi.org/10.1212/WNL.0000000000207214).
*This article is educational and does not replace advice from a neurologist. Prognosis is individual — talk to your doctor about your specific case.*