MS Disease-Modifying Therapy May Safely Be Discontinued in Older Patients

Most patients with multiple sclerosis (MS) who discontinue disease-modifying therapy (DMT) after age 60 experience do not reinitiate therapy, according to a recent study published in Multiple Sclerosis Journal.

This retrospective observational study sought to better understand the implications of disease-modifying therapy discontinuation in individuals >60 years old by examining data of patients treated at Cleveland Clinic MS centers between 2010 and 2016.

Of the 600 patients in the cohort who met the study criteria, 178 (29.7%) discontinued DMT. To be evaluated as part of the discontinuation group, individuals needed to have been on DMT for ≥2 years and must have ceased receiving DMT after age 60.

Although there was a significantly higher death rate for patients who discontinued DMT, this difference is most likely associated with the longer disease duration and older age of those who discontinued DMT, as no differences in MRI volume loss or lesion burden were found between the 2 groups.

Most patients did not have available thoracic spine MRIs, however, so the impact of discontinuation on disability treatment decisions or outcomes could not be analyzed. Only 10.7% (n=19) of discontinuers reinitiated DMT, and only 1 documented case of relapse was found among the 178 patients who discontinued.

These findings demonstrate that DMT discontinuation may be more successful for older patients with multiple sclerosis. These patients tend to fall into 2 categories for discontinuation, the first being stable patients with minimal or mild disability, for whom the inflammation phase of the disease appears to have “burnt out;” and the second being progressive patients with significant disability, for whom disease-modifying therapy provides marginal benefit.

Both of these groups did well following discontinuation, but the study was unable to adequately evaluate the differences between the two, as there was insufficient data for analysis.

Investigators conclude, “we hope these results drive the discussion toward understanding the changes occurring with age in MS patients. This study can also offer some reassurance when considering DMT discontinuation in older MS patients.”

Please refer to reference for full list of disclosures.

Reference

Hua LH, Fan TH, Conway D, Thompson N, Kinzy TG. Discontinuation of disease-modifying therapy in patients with multiple sclerosis over age 60 [published online March 1, 2018]. Mult Scler. doi: 10.1177/1352458518765656