The following is a summary of “Navigating the discontinuation of multiple sclerosis first-line treatments: A paradigm shift in patient care,” published in the February 2024 issue of Neurology by Ozen et al.
Injectable disease-modifying therapies (DMTs) are commonly used to manage multiple sclerosis (MS), but some patients discontinued them.
Researchers conducted a retrospective study to identify why patients stopped injectable MS treatments and how this impacted their disease course.
They analyzed data from 2,270 patients who had been on injectable DMTs for over two years and stopped due to clinical and MRI remission, side effects, or non-compliance. The patients fell into two groups: those stable after discontinuation (SAD) and those who experienced relapse after discontinuation (RAD)—survival analysis and logistic regression determined factors impacting treatment cessation.
The results showed that out of 60 patients who stopped DMTs, 1/3 (n = 20) remained stable, while 40 had clinical and/or MRI activity later. The SAD group stopped treatment at a significantly older age than patients with RAD (35.9 ± 11.1 vs. 30.7 ± 6.1, P=0.025). Patients under 40 had a 75% chance of worsening, while those over 50 had an 80% stability rate. Patients with SAD used DMTs longer than patients with RAD (69.1 ± 47.3 vs. 46.6 ± 20.3 months, P=0.012). A considerable portion (42.9%) of worsened patients stopped DMTs without medical advice, highlighting adherence challenges. Patients with RAD had relapses around 21.0 months post-discontinuation. Survival analysis suggested a more favorable disease course for those who stopped treatment after stability (P=0.237), with distinctions emerging after four years. Older age at discontinuation lowered relapse risk (HR: 0.904; P=0.031; 95% CI: 0.825, 0.991). Stopping treatment for reasons unrelated to stability had a positive but uncertain impact on relapse likelihood.
Investigators concluded that discontinuing injectable DMTs in patients with MS may impact disease progression, with age and reason for cessation playing a role.
Source: msard-journal.com/article/S2211-0348(24)00082-8/abstract#%20