WASHINGTON – Nearly 40% of clinically-stable multiple sclerosis patients who stopped taking their medication had some degree of disease activity return, according to new research presented at the American Academy of Neurology 2015 Annual Meeting.
Ilya Kister, MD, of the NYU Langone Multiple Sclerosis Comprehensive Care Center, and colleagues prospectively studied 181 patients from the international MSBase Registry for MS relapse rates and disability progression rates in those who stopped taking disease-modifying therapies. Patients were aged 40 years or older and had experienced no relapses or reported stable disability progression (via EDSS scores) for at least five years, and had been taking MS medication for at least three years. After therapy was ceased, patients were followed at least three years.
Twenty-four percent of patients reported a relapse, 32% sustained three-month disability progression, and 10.6% reported both relapse and disability progression. Forty-two percent of patients restarted medication after a median of 22 months, which was associated with a 59% reduction in risk of disability progression.
“Despite long periods of disease stability while taking medication, we found a large minority of patients who stopped experienced relapses or disability progression,” said Kister. “We need to identify situations when it is safe for patients with MS to stop taking these medications.”
There previously was little known about MS disease progression after stopping first-line therapies in clinically-stable patients. Reasons that patients may discontinue use of disease-modifying therapies include side effects, perceptions of health, continued exacerbations of disease symptoms, or for insurance purposes.
“Decisions regarding stopping disease-modifying therapy may have implications for short and long-term prognosis. We know a lot about what happens when therapy is started, but we know very little about what happens when therapy is stopped,” said Kister.
To further address this little-known factor and establish if and when it may be safe for patients to discontinue medication use, Kister and colleagues suggested that randomized trials be conducted on the discontinuation of disease-modifying therapies.
- Kister I et al. Abstract P5.192. ‘Doctor, can I stop my medicine?’ Analysis of disease course after stopping disease-modifying therapy in stable MS patients. Presented at: American Academy of Neurology Annual Meeting 2015; April 18-25, 2015; Washington, D.C.